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Timestamp: 2019-08-18 01:47:21
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Ten-takeaways | News | Natmed Medical Defence
Informed Consent Part 5 - Consent for termination of pregnancy
Natmed’s Ten Takeaway series is a first stop point of reference for busy healthcare practitioners and healthcare facility operators and intended to be reference in conjunction with the Natmed “What If?” series, Natmed Medical Defence Review and the Natmed Glossary of Medical Negligence and Insurance Terms.
Only the pregnant woman’s consent is required for a termination of pregnancy (during the first 12 weeks of gestation). Consent must be informed consent.
You must provide information relating to the patient’s health status (except if there is substantial evidence that providing the information would be contrary to the patient’s best interests).
You must set out the range of diagnostic procedures and treatment options generally available to the patient.
You must explain the benefits, risks, costs and consequences generally associated with each option.
You must explain the user's right to refuse health services.
You must explain the implications, risks and obligations of a refusal of health services.
Where possible, the information listed above must be provided in a language that the patient understands.
When providing information to a patient, you must take into account the patient’s level of literacy.
Patients must not be pressured or unduly influenced into accepting a healthcare practitioner’s advice or recommendations for any medical treatment.
You should check that the patient understands all of the above issues relevant to consent, to ensure that whatever decision the patient makes is properly informed.
Informed Consent Part 4 - Special rules for emergencies
The rules for informed consent are different in an emergency situation where a patient is unable to give consent (for example they are unconscious) and irreversible damage to their health or death will result if medical assistance is delayed.
If the patient is unable to consent to or refuse medical treatment, consent may be provided by the following people, in this order: a person mandated in writing by the patient to provide consent on their behalf; a person authorized by any law or a court order to give consent; the patient’s spouse or partner; the patient’s parent, grandparent, adult child, adult brother or sister. This hierarchy is set out in section 7 of the National Health Act.
If a family member or authorized representative is not available at the time of an emergency to give consent, treatment should be initiated and an effort should be made to contact the family or representative in order to obtain consent as soon as possible. Section 5 of the National Health Act says that a health care provider may not refuse a person emergency medical treatment.
An emergency situation does not override a patient’s prior express refusal of certain medical interventions (for example the patient, while conscious and alert, expressed that they do not want to be resuscitated under specific circumstances, and they are now unconscious). However, consent is not required if a failure to treat the patient will result in a serious risk to public health.
Generally, if a patient recognizes their surroundings and the people around them, they are able to consent to or refuse treatment.
If a patient is conscious but confused, acting against his or her wishes in an emergency may be justified. However, just because the patient’s choice to refuse treatment may seem irrational to the doctor is not evidence in itself that the patient lacks capacity to make the decision.
The medical practitioner must assess the patient’s mental capacity as far as possible before acting on the refusal of treatment inan emergency.
After necessary emergency medical treatment is given, the patient must be informed of the details relating to the medical treatment already provided and must also be provided with all the relevant information necessary for the patient to decide if they would like to continue further treatment.
If a patient is admitted to a hospital or other health establishment without consent, the relevant provincial authority must be notified of the admission within 48 hours unless the patient consents to the provision of any health service in that health establishment within 24 hours of admission.
A patient can withdraw consent at any time.
Informed Consent Part 3 - Special rules for children (minors)
Minors may need parental consent for medical treatment, but in specific circumstances they may validly consent on their own to medical treatment. Anyone under the age of 18 is a minor.
A child of 12 years or older with sufficient maturity is allowed to consent to their own medical treatment or to treatment for their own child. In the case of a surgical operation, children must be assisted by a parent or legal guardian.
With regard to termination of pregnancy, only the pregnant woman’s consent is required – in the case of a minor, the healthcare practitioner must advise the pregnant child to consult with parents, guardians or family members regarding the termination but may not refuse the termination of pregnancy if the minor chooses not to consult with them. There is no minimum age limit for this consent to be valid.
Condoms may be provided to children over 12 on request, without parental consent. Contraceptives other than condoms may be provided to a child over 12 without parental consent if proper medical advice is given to the child and a medical exam is carried out on the child to determine whether there are any medical reasons why a specific contraceptive should not be provided. A child who obtains contraceptives is entitled to confidentiality.
A child may give consent to HIV testing if they are 12 years or older, or if they are younger than 12 but show sufficient maturity and understanding of the implications of the test. For HIV testing of children younger than 12 who do not have sufficient maturity to consent, consent of the parent, guardian, court or other legal authority (whichever is relevant in the specific circumstances) is needed.
Female circumcision is prohibited regardless of the age of the patient. Male circumcision is allowed for males under the age of 16 for religious or medical reasons only. Males over the age of 16 may consent to circumcision after they have received counselling and have given consent to the procedure. Taking into consideration the child's age, maturity and stage of development, every male child has the right to refuse circumcision.
The medical practitioner must assess whether a minor has sufficient maturity to consent on their own. The child has to understand the benefits, risks and implications of the treatment in order to be seen as a child of sufficient maturity. If you are unsure of a minor’s capacity, always consult with a senior colleague. When relaying information to a minor in order to obtain their informed consent, you need to take into account their level of maturity and explain all information on their level.
Where children do not possess sufficient maturity or are below the age of 12, consent must be given by a parent or legal guardian, or the superintendent or person in charge of a hospital, the Minister of Health, or a High Court or Children’s Court.
If a parent or guardian will have to pay for the medical services, they have to give consent to pay for it, except in cases of emergency or where the procedure or treatment is necessary and in the best interest of the child.
No parent may withhold consent for medical treatment by reason of religious beliefs, unless the parent can show that there are medically accepted alternatives.
Informed Consent Part 2 - What information must a healthcare practitioner provide?
Ten Takeways - Informed Consent Part 2 - What information must a healthcare practitioner provide?
In order for consent to medical treatment to be “informed”, the healthcare practitioner must give the patient sufficient information to make their decision.
Ten Takeways - Informed Consent Part 1
You cannot treat a patient without their informed consent.
Informed consent requires the patient to have full knowledge of their diagnosis, proposed treatments and its risks and complications, alternative treatment, and the patients’ right to refuse treatment and the consequences of that refusal.
In obtaining informed consent you must use a language and communicate in a manner the patient understands.
Treating a patient without their informed consent is a violation of the patients’ right to body or physical integrity.
A patient has the right to refuse treatment except where the refusal may harm others.
Consent, if given may be withdrawn by a patient at any time.
Special rules apply to consenting to a termination of pregnancy or sterilisation.
Special rules apply to consenting to medical treatment or a surgical operation in respect of a child.
Special rules apply to consenting to medical treatment of mentally ill persons.
Special rules apply when a person agrees to participate as the subject of medical research, or to donate human tissue.