Toconclude from this module, (4004) I have expanded my knowledge on the principleand laws to do with consent. There are many laws and regulations put intopractice to ensure a patient is given the best service possible.
I am also nowaware of the different acts that are linked in with consent. I have learnt howto communicate with dementia patients, also how to approach a situation wheresomeone refuses treatment, and how to deal with it. Furthermore, I have gainedawareness on the ethical and legal issues surrounding consent. overall the keyissue is whether a patient has the capacity to consent.
Are they competentenough to make a well enough decision? Tosum up this essay, patients with dementia should not be treated any differentlyto patients without dementia. They should also be treated in a way where Beneficenceand Non-maleficence is considered before examining them. Assuming a patient isincapable of consenting to an examination is discriminating. A person (A) discriminates against a disabled person (B) if— (a)A treats B unfavorablybecause of something arising in consequence of B’s disability. (Equality Act). Ihave leant to ‘understand the need to respect and uphold the rights, dignity,values, and autonomy of service users including their role in the diagnosticand therapeutic process and in maintaining health and wellbeing’ (HCPC) Inrelation to consent and these SoR principles Radiographers should not assumethat a patient is incapable of deciding. The Radiographers should firstlysupport the patient in helping them to decide.
They could also ask the patientscarers to help, however they cannot give consent on behalf of the patient. If,however, they are still not able to consent; acting in the best interest wouldbe the next step. Thereare 5 key principles in the SoR to do with capacity.
Number 1 is ‘presumptionof capacity’ – every adult has the right to make his/her own decision and musthave capacity to do so’. A patient with dementia, shouldn’t be assumedincompetent unless proven otherwise. Number 2 is the ‘right for individuals to besupported make their own decisions’ – patients should be given all the helppossible before anyone concludes that they are incompetent to consent. Number 4is ‘best interest’ – anything done on behalf of someone without capacity mustbe in their best interests. Number 5 is the ‘least restrictive intervention’ –anything done on behalf of someone should be the least restrictive of theirbasic rights and freedoms.
Communication can be divided into 2 aspects: Verbal& Non-verbal. Verbal communication is the use of sound and words,expressing oneself by talking. Non-verbal communication is expressing oneselfwith actions, hand gestures, eye contact and body movement. When dealing withpatients with dementia, the imaging professional should attempt to use bothVerbal and Non-verbal communication with the patient.
This is because due tothe condition the patient may find it difficult to process what theRadiographer is trying to say. If this was to happen then sometimes the patientcould get frustrated and angry, which would cause miscommunication between theconversation. Therefore, prior imaging a patient the Radiographer shouldexplain the process.
The HCPC (8.1) also indicates that Radiographers should ‘beable to demonstrate effective and appropriate verbal and non-verbal skills incommunicating information, advice, instruction and professional opinion toservice users, colleagues and others’. (HCPC) To communicate with a dementia patient the imagingprofessional should get the patients attention as efficiently as they can. Theyshould try and avoid loud noise and should limit any distractions. For thepatient to fully understand them.
The professional should also state themessage as clearly as possible, they should use simple language and be straightto the point. They should speak slowly and clearly so the patient understandsthem. The imaging professional should ask closed questions, as it is easier forthe patient to answer. They should give time for the patient to answer thequestion properly. Reassuring the patient, and explaining the procedure thepatient will be less conscious and worried. Communication with dementia patients can be quitedifficult, as dementia causes memory loss. This means that the imagingprofessionals working with the dementia patient should be patient andunderstanding. Throughout the whole procedure the professionals should try andmake conversation with the patient and reassure them that they are safe.
If thepatient is calm and relaxed, then the procedure will go well. If theprofessional does not have effective communication skills, then the dementiapatient may sometimes get confused which would lead to them panicking. Therefore,ensuring the patient is at peace will making the process easier for both thepatient and the professional. Justice is the principle of fairness. However, for animaging professional, it means that a correct/suitable procedure should becarried out after consent. Patients with dementia should not be treateddifferently or unfairly, due to their condition. This implies, that the sameequipment should be used for a patient with dementia as well as someonewithout. Beneficence is the performance of good acts andpreventing evil.
This ethical issue requires professionals to do good topatients and prevent any harm. Beneficence is similar to making a ‘bestinterest decision’. It is done for the benefit of others. This connects withpatients with dementia as professionals need to apply beneficence when they aredealing/examining the patient. Non-maleficence on the other hand is avoidingevil. The professionals weigh out the risks and benefits and consider which oneis more beneficial to the patient. An imaging professional should firstlycontemplate, whether an x-ray image should be taken, if it is beneficial to thepatient, whether the benefits outweigh the risks.
As the professional should beapply Non-maleficence before any examination. The difference betweenBeneficence and Non-maleficence is that the stronger ethic is Non-maleficence.This is because the imaging professional is avoiding harm to the patientwhereas Beneficence – the performance of good is weaker. A decision should bemade after considering both Beneficence and Non-maleficence. There are also ethical issues surrounding capacityto consent.
The 4 issues I will be talking about are: Autonomy, Beneficence,Non-maleficence and Justice. Autonomy is defined as when ‘one human person,precisely as a human person, does not have the authority and should not havepower over another human person’. Autonomy links in with consent as it is amust that the patients’ autonomy is considered, before a procedure likeimaging.
Autonomy is a way of receiving an informed consent off a patient.Imaging professionals should be efficient in explaining the facts andstatistics to inform the patient on the risks and benefits. ‘Familiarity with professional codes of ethics and understanding of ethicalschools of thought, patient-professional interaction models, and patients’rights prepares imaging professionals to address future ethical dilemmas. Whendifficult situations arise, they have already thought through the variouscourses of action and can respond in keeping with their personal standards ofethics’ (Ethical and legal issues for imaging professionals). Doreen is tryingto imply that the professionals should be aware of the different laws andethics whilst imaging a patient, because if they were ever in a difficult situationthen they would know how to deal with the patient.
‘Be able to exercise a professional duty of care'(HCPC), acting in a professional way with patients is very important. Especiallywhen these patients suffer from dementia and need that extra assistance, the Radiographersshould be professional in the way they treat the patient. The Human Right Act (1998) lets a person definetheir rights to treat people equally, fairly and with respect. The articles inthe Act make sure every individual is not discriminated due to their opinion.Article 2 is all about ‘right to life’. This proves that nobody can try to enda life, it protects your right to life. This interlinks with capacity toconsent, because if a patient was incompetent to decide on their own then thisArticle will help professionals when making an overall decision.
Article 3protects someone from torture, mentally or physically. Article 4 talks aboutliberty. Both Articles 3 & 4 indicate that an individual cannot be forcedinto making a decision which would affect them. They have full right to makingtheir own. Article 10 ‘protects your right to hold your own opinions’ (freedomof expression).
Patients can refuse treatment, even if it is going against whata professional would recommend. This leads onto Article 14, which is on discrimination,an individual’s decision cannot be discriminated upon, as everyone is qualifiedfor their own demeanour and choices. Nevertheless, all these Articles come downto whether the patient is competent or not. The Duty Of Health (DOH) – 12 points of consent,also indicates different scenarios/types on when consent is needed. The definitionof consent is giving permission for something to happen. The reason as to whyinformed consent is so significant is because the patient should be aware ofall the risks and benefits that would be arising from the type of treatment theywill be having. In this case imaging a patient, has risks as well as benefits. Therefore,the patient has full right to be informed on all the possible factors.
One ofthe points mentions that ‘adults are always assumed to be competent unlessdemonstrated otherwise’. This links in with The Mental Capacity Act when’assuming capacity’. Hence the radiographer should not assume that the dementiapatient will be unable to give consent. The consent should be valid.
This meansthe patient should be given ‘sufficient information before they can decidewhether to give their consent’. If the patient is not given the full detail onthe procedure, then the consent would not be fully validated. It is mentionedin the points that ‘competent adult patients are entitled to refuse treatment,even where it would clearly benefit their health’. This proves that patientscan refuse to treatment, and healthcare professionals should accept theirdecision, even if it is not favouring them.
Furthermore, if a patient isincompetent then no one can give consent on behalf of them, as they don’t havethe authority to. If an incompetent adult has indicated in the past, that theywould refuse this certain type of treatment, then the professional should abideby the refusal and respect their decision. Radiographers and healthcare scientists work in anenvironment where dementia patients are regular patients. Even though this isthe case, Principle 1 in the Mental Capacity Act, explains that you should notassume capacity. This implies not assuming something about a patient before youhave met. Assuming they have no ability to agree because of their therapeuticcondition or incapacity, even before the examination, is discriminating (EqualityAct). This then leads onto Principle 2, ‘individuals supported to make theirown decisions’.
Professionals are encouraged to help/assist patients withdementia making their own individual decisions. Healthcare professional need tomake sure they don’t make the decision for them, however support the patient inmaking their own. If after these 2 steps, the patient makes an unwise decision(principle 3), radiographers should respect their decision, even if it issomething that is not beneficial. The patients’ values and beliefs should beaccepted by the radiographer as everyone is entitled to their own opinion. Thisconnects to the Human Right Act Article 10 – where ‘freedom of expression’ isexplained. Everyone has the right to freedom of expression. Principle 4 is allabout ‘best interest’ – this isconsidering the patients best interests and then making an overall decision onthat. When making a best interest decision the healthcare professional shouldspeak with the relatives before beginning any procedures.
Under the HCPC (2.1) it is stated thatRadiographers must ‘understand the need to act in the best interests ofservice users at all times’. The final Principle(5) is the ‘less restrictive option’. This is when someone makes the decisionon behalf of the patient who lacks the capacity to make their own decision. Theperson making the decision must consider the patient’s rights and beliefs priorin deciding with anything. Overall it comes down to whether the patient hascapacity to consent or not. Workingas a healthcare professional means you deal with patients with dementia.
Dealing with such patients can be very troublesome and hard. In this way, a fewprocedures are placed to carry certain techniques like Imaging. Patients withdementia do not always have the capacity to consent.
However, some patients arestill able to give consent. This all comes down to autonomy – where everyone isentitled to make their own decisions. ‘Autonomy is the concept that patients are to be treated as individuals andinformed about procedures to facilitate appropriate decisions’. This conceptrelates to the DOH – 12 points of consent. Point 1 notices ‘before you examine,treat or care for competent adult patients you must obtain their consent.’ Thisclearly proves the significance of valid/legitimate consent. A competent patientmeans ‘having the necessary ability, knowledge, or skillto do something successfully.
‘ If the patient has the capacity to consent, theradiographer should accept the decision of the patient, whether it isbeneficial or not to the patient. The Human Right Act Article 10 portrays thefreedom of expression – which indicates the right to your own opinion freely.Healthcare professionals should respect this off the patients and not take ablind eye at it. Firstly,before settling on a choice in a matter whether a patient has the ability to assent.
The patient should be able to ought to have the capacity to comprehend thechoice to be made and the data given. Has the patient been given allinformation required? Thereafter the patient should be able to retain theinformation. They should be given enough time to make a decision, as they havefull right to. Thirdly the patient should utilize that data to settle on an officialchoice – they should weigh out the pros and cons, and then conclude from that.Lastly, the patient should communicate their decision with a healthcareprofessional. If a person cannot give consent at that certain time as they maybe unconscious for e.
g. then the professional should treat them as though theylack capacity.Consentingto procedures/treatments implies the patient is educated, of the advantages anddangers of the procedure. However, some patients do not have the capacity toconsent.
These patients incorporate individuals with dementia. Dementia is acondition where somebody endures with side effects, for example, memorymisfortune and find it difficult when thinking. Due to the confusioninfluencing the mind and influencing the way a man would think – there arerules and regulations put into place to conclude whether a patient is competentto make a suitable decision for themselves. Do they have the capacity toconsent? Consent can be determined in 4 ways: 1) Communication 2) Understanding3) Appreciation 4) Realisation/Reasoning.
These 4 components assess thecapacity of an individual. Inthis essay I will be discussing the legal, ethical, professional and communicationissues within imaging a patient with dementia. The aim of the essay is to takean insight on all the possible factors when dealing with a dementia patient,and how regulations are put into place for situations like these.