Capacity to Consent- Common Ethical Scenarios

Updated: May 7, 2020

By Usman Nasir


Before this article, check out the previous one called “Everything about ethics at interviews” to read about how to approach ethical scenarios and questions.


Firstly, some points about consent…


· An adult can consent or refuse any treatment, if they are deemed to have capacity (i.e. they can understand information presented to them, process it, weigh up the options and relay their decision back to you).

· A child (under 16) can consent to treatment, if they are Gillick competent, but CANNOT refuse treatment


IMPORTANT: Practising Jehovah’s Witnesses do not accept blood transfusions or any primary components of blood such as red blood cells, platelets, plasma or white blood cells.


This may seem like a complex question at first, so break it down to make it easier for yourself:

1. The patient is an adult, so ask yourself whether they have capacity? This can be the first point to your argument.

2. Once you have established whether they have capacity, then you can move on to the main chunk of the scenario.

3. Check whether the patient is practising. Even if a patient is known to be a Jehovah’s Witness, they may not follow all aspects of the religion. Talk to the patient about their ideas and double check with them, so you have a clear understanding of their beliefs.

4. Make sure the patient understands that a blood transfusion is needed to save their life.

5. If the patient still refuses, then question if there are any other alternative options available to them that does not require a blood transfusion.

6. But if a blood transfusion is the only option and the patient still refuses then, you have to respect their autonomy, as they are competent and have the right to refuse treatment as an adult. Just because you may disagree with their decision does not mean they are not competent, so you cannot force them to have the treatment. It is their decision, so this is in their best interests, as going against them would be very distressing for them (LINK to ethical pillars of AUTONOMY and BENEFICENCE).

7. Remember to mention that you would not make such a decision by yourself. You would consult an ethics committee and the multi-disciplinary team.


Something to think about:


What if the patient was unconscious?


· If a patient is unconscious, then they are obviously not competent to make a decision.

· If it was listed in their medical records that they were Jehovah’s witness and would refuse any blood transfusion, then the scenario wouldn’t change.

· But if it there was any doubt about their beliefs (i.e. you were unsure if they were a practising Jehovah’s Witness or if they would refuse a blood transfusion) then you would consult their family, as part of deciding of what is in the best interests of the patient. You can override the family, if you feel that is in the best interests of the patients. This needs to be justified in documentation.


What if the patient was under 16?


· This is slightly different as children can consent to treatment if they are Gillick competent, but they CANNOT refuse treatment if they are underage.

· You would therefore consult the child’s parents, but even this can be overridden if you feel that it is in the child’s best interests.


Scrubbed up Tips


· Make sure you understand what consent is and the differences between children and adults.

· Have some basic knowledge of what Jehovah’s Witness believe regarding blood transfusions.

· This scenario could easily be part of a role play station so practise with friends and family.

· Reference the ethical pillars throughout.


References


Consent –

https://www.ahn.org/services/medicine/bloodless-medicine/faq/minor-blood-fraction

AHN Is a Minor Blood Fraction a Small Amount of Blood

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