1. Capacity and Consent
Heidi Robertson
02 April 2014

2. Consent
Permission for something to happen or agreement to something.
Informed Consent
Permission granted in full knowledge of the possible consequences.

3. Consent InvolvesConsent Involves

Establishing TrustEstablishing Trust

Promoting InvolvementPromoting Involvement

RespectRespect

Enabling informed decisionsEnabling informed decisions

Being aware of and involving representativesBeing aware of and involving representatives

Supporting safe, ethical and competent careSupporting safe, ethical and competent care

4. College of Occupational TherapistsCollege of Occupational Therapists

Under law you must seek the consent or permission of your serviceUnder law you must seek the consent or permission of your service
user before you carry out any assessment and/or intervention.user before you carry out any assessment and/or intervention.

You should provide your patient or others acting on their behalf withYou should provide your patient or others acting on their behalf with
sufficient information, in an appropriate manner, to understand thesufficient information, in an appropriate manner, to understand the
nature and purpose of the proposed interventionnature and purpose of the proposed intervention

You should record when consent is sought and the outcome.You should record when consent is sought and the outcome.

Where Capacity to give informed consent is restricted or absent, youWhere Capacity to give informed consent is restricted or absent, you
must seek to act in their best interests and document decisions andmust seek to act in their best interests and document decisions and
actions.actions.

5. CapacityCapacity

Understand the proposed treatmentUnderstand the proposed treatment

Understand benefits, risks and alternativesUnderstand benefits, risks and alternatives

Have an understanding of consequencesHave an understanding of consequences

Can retain informationCan retain information

Can communicate their decisionCan communicate their decision

Can hold a consistent decisionCan hold a consistent decision

6. How capacity is assessedHow capacity is assessed

No single universally accepted toolNo single universally accepted tool

Screening for cognitive impairmentScreening for cognitive impairment

Medical staff have main responsibility but theyMedical staff have main responsibility but they
rely on multi-disciplinary consultation.rely on multi-disciplinary consultation.

Not due to eccentric/unusual or unwiseNot due to eccentric/unusual or unwise
decisions.decisions.

7. Factors influencing capacityFactors influencing capacity

Personal, physical, psychosocial and situational demandsPersonal, physical, psychosocial and situational demands

Resources and supports availableResources and supports available

Pain, discomfort, medicationPain, discomfort, medication

InfectionsInfections

Mental IllnessMental Illness

Learning DisabilityLearning Disability

DementiaDementia

Acquired Brain InjuryAcquired Brain Injury

Severe communication difficultySevere communication difficulty

8. Factors influencing capacityFactors influencing capacity

ApathyApathy

AgitationAgitation

Attention deficitAttention deficit

AnxietyAnxiety

IrritabilityIrritability

DepressionDepression

DisinhibitionDisinhibition

GriefGrief

Problem Solving, Organisation, JudgementProblem Solving, Organisation, Judgement

Sleep disturbanceSleep disturbance

9. To ConsiderTo Consider

Should never be assumed to be incapable of making decisions.Should never be assumed to be incapable of making decisions.

May need to consider future decision making.May need to consider future decision making.

May have fluctuations in cognitive functioningMay have fluctuations in cognitive functioning

Long history that will influence their response to their present circumstancesLong history that will influence their response to their present circumstances

Cultural diversity.Cultural diversity.

Increased prevalence of medical problems in older peopleIncreased prevalence of medical problems in older people

May be especially concerned about others trying to force them out of theirMay be especially concerned about others trying to force them out of their
home and in to long term carehome and in to long term care

10. Supporting Decision MakingSupporting Decision Making

Take time to explain anything of relevance to help the person make decisionTake time to explain anything of relevance to help the person make decision

Try not to burden the person with more information than needed.Try not to burden the person with more information than needed.

Describe forseeable consequences – risks and benefitsDescribe forseeable consequences – risks and benefits

Explain the effects the decision might haveExplain the effects the decision might have

If there is a choice, give the same information in a balanced wayIf there is a choice, give the same information in a balanced way

Consult family members or whoever knows the person wellConsult family members or whoever knows the person well

Use simple language, pictures, objectsUse simple language, pictures, objects

Ask one question at a time, don't rush give time for reflectionAsk one question at a time, don't rush give time for reflection

Speak at the right volume and speedSpeak at the right volume and speed

Consider communication aidsConsider communication aids

Consider time, place.Consider time, place.

11. Capacity and Consent
02 April 2014