CONSENT

PRINCIPLES

• A patient can personally accept or refuse an intervention only if:
  • they are competent to make that decision

AND

• once full informed consent is provided

• You are obliged to intervene only if the condition is LIFE-THREATENING and the patient is NON-COMPETENT and there is NO CONTRAVENING LEGAL DIRECTIVE
• In NON-URGENT conditions, it is advisable but not necessary to obtain direction from a legal authority e.g. parent, guardian, court before treating a non-competent patient

Hence,

• Any condition + Competent patient + No consent + Intervention = ASSAULT
• Non-life threatening condition + Non competent patient + No consent + Intervention = ASSAULT
• Life threatening condition +  Non-competent patients + No prior legal directive + No intervention =  NEGLIGENCE 

COMPETENCY

• A patient demonstrates competency if they demonstrate appropriate understanding, insight and judgement regarding the decision they make and the immediate consequences that may result

See Competency

THE AGE OF CONSENT

• Age at which individuals (assuming there is no other reason not to do) are automatically given the right to accept or refuse medical treatment/procedure (age of consent) without interference
• Age of consent = 14 (NSW) 16 y.o. (S.A) 18 y.o. (all other states)
• Age of itself is not a determining factor of competence
  • The choices that they are capable of making depends on the individuals understanding and maturity
  • It may vary according to what choices they are offered e.g. a 10 year old may be able to agree to have a plaster case applied but not to major elective surgery
  • A child may be capable of making choices but unlike an adult can have their decisions challenged by a parent/guardian (and may eventually need to be settled in court)
• Although advisable, it is not necessary to obtain the consent of a parent/guardian if you are satisfied with the patients competency (see Right to privacy)

URGENT CONDITIONS

• The urgency to treat exists on a spectrum e.g. CPR in an arrest, thrombolytics for MI, blood transfusion for haemorrhage, surgery for ruptured appendix
• If possible always obtain some form of consent first - else treat