7

MCA in clinical decisions for care and treatment

Introduction

Individuals have the right to freedom of choice for the treatment and care they receive. “An adult person of sound mind is entitled to decide which, if any, of the available forms of treatment to undergo, and her consent must be obtained before treatment interfering with her bodily integrity is undertaken” (Montgomery v Lanarkshire [2015] paragraph 87).

Healthcare practitioners must follow due processes to support individuals in this right, in terms of ensuring informed consent for any treatment and care (Department of Health 2009; Care Quality Commission 2011). All registered health professionals are bound by their regulatory and registering bodies published standards to ensure appropriate consent is gained, before any treatment or care is undertaken. Supporting individuals in giving informed consent for clinical decisions, becomes a basic principle for all practitioners involved in the planning and delivery of clinical treatments and care(Bonsall 2015; Regan & Sheehy 2016; RCN 2017; Griffiths 2017).

The BMA is clear that consent to treatment decisions require the possession of “sufficient” mental capacity (BMA 2018); the definition of “sufficient” will depend upon the complexity of care and treatment being proposed. Health and social care practitioners are in an ideal position to support individuals with giving informed consent to treatment and other health and care activities. As part of their daily work practitioners provide support to help individuals overcome barriers to their ability to give consent, for example, through the provision of clear and accessible information.

The promotion of autonomy and self-determination are key elements of legal and ethical practice as individuals have the right of choose the care and treatment they receive, as well as assurance that appropriate processes will be used to support them in giving consent.

Valid consent to treatment and care requires the individual to:

  • Understand what the proposed treatment involves
  • Be able to weigh up the risks and benefits
  • Communicate their consent
  • To do so without undue pressure, influence or force

(GMC 2008; RCN 2017; CQC 2011; BMA 2018, NICE 2018).