In this series of articles, medical students from across the country will discuss a range of topics from medical ethics to the NHS to public health to medical conditions to clinical governance.
These articles give you a basic overview of the principles; we have attached videos and useful websites to develop a more detailed insight.
Autonomy is the first pillar of medical ethics and is the right of competent adults to make informed decisions about their own medical care. The principle underlies the requirement for medical practitioners to seek the informed consent of their patient before any investigation or treatment takes place. Patients also have the right to refuse receiving information. The pillar of Autonomy becomes most pivotal when patients who are deemed as competent are able to refuse life-sustaining treatment if they wish. Competent adults' decisions regarding their choice to accept or decline care must always be respected.
⚖️The Law
“An adult patient who… suffers from no mental incapacity has an absolute right to choose whether to consent to medical treatment… This right of choice is not limited to decisions which others might regard as sensible. It exists notwithstanding that the reasons for making the choice are rational, irrational, unknown or even non-existent.” Lord Donaldson. Re T (Adult) [1992] 4 All ER 649.
In order to have capacity, a patient over the age of 16 must have:
Understanding: the patient's ability to understand the meaning of information provided by their doctor
Be able to retain information: the patient should be able to remember the information provided by their doctor
Reasoning: the patient's ability to determine how facts are relevant to their situation and use the information provided to make decisions regarding their care
The ability to express a choice: the patient should have the ability to clearly communicate their choice of treatment
Medical practitioners should assess a patient’s capacity to make a particular decision at the time it needs to be made. They must not assume that because a patient lacks capacity to make a decision on a particular occasion, they lack capacity to make any decisions at all, or will not be able to make similar decisions in the future.
🛣️Mental Capacity Act (applies to individuals aged 16 or over)
The Mental Capacity Act of 2005 is designed to protect people who lack capacity and empower individuals who may have reduced capacity to make their own decisions about their care and treatment. Through an Advance Directive, the act allows people to make decisions about their future health treatment in the event that their mental capacity may become reduced - these are essentially used to make advanced decisions to refuse treatment. It also allows individuals to appoint a Lasting Power of Attorney (someone who would make decisions on the individual's behalf in the future if they became unable to make them themselves).
🧒Gillick Competency (for individuals under 16 years of age)
Children under the age of 16 can consent to medical treatment, without the need for parental permission or knowledge, if they have sufficient maturity and judgement to enable them fully to understand what is proposed. For example, a 15-year-old Gillick competent boy can consent to receiving tetanus immunisation even if his parents do not agree with it. However, even though a young person may be considered to be Gillick competent, there are some situations where their refusal can be overridden by those with parental responsibility / a medical professional and legal advice may be required. It may be necessary for a court to determine whether treatment can be given against the wishes of the competent young person.
🩸Clinical Case - Child who is a Jehovah’s Witnesses and requires a blood transfusion
Some Jehovah’s Witnesses believe that it is against God’s will to receive blood and, therefore, they refuse blood transfusions, often even if it is their own blood. If a child’s parent refuses to consent to the administration of a blood transfusion for this reason, the medical practitioner may, in terms of the Children’s Act (2004), ignore such refusal and administer the blood transfusion.