examination
Jack’s examination
View more of Jack’s story below to see how his examination went.
![Jack’s examination Slide](http://clinicalethics.healthcare/wp-content/plugins/revslider/public/assets/assets/dummy.png)
![narrative10208a](http://clinicalethics.healthcare/wp-content/plugins/revslider/public/assets/assets/dummy.png)
for the blood test...
![narrative10208b](http://clinicalethics.healthcare/wp-content/plugins/revslider/public/assets/assets/dummy.png)
![narrative10209](http://clinicalethics.healthcare/wp-content/plugins/revslider/public/assets/assets/dummy.png)
and she will consent to the blood test on his behalf.
![narrative10210a](http://clinicalethics.healthcare/wp-content/plugins/revslider/public/assets/assets/dummy.png)
do next is required, Coral states...
![narrative10210b](http://clinicalethics.healthcare/wp-content/plugins/revslider/public/assets/assets/dummy.png)
![Jack’s examination Slide](http://clinicalethics.healthcare/wp-content/plugins/revslider/public/assets/assets/dummy.png)
![narrative10208a](http://clinicalethics.healthcare/wp-content/plugins/revslider/public/assets/assets/dummy.png)
for the blood test...
![narrative10208b](http://clinicalethics.healthcare/wp-content/plugins/revslider/public/assets/assets/dummy.png)
![narrative10209](http://clinicalethics.healthcare/wp-content/plugins/revslider/public/assets/assets/dummy.png)
and she will consent to the blood test on his behalf.
![narrative10210a](http://clinicalethics.healthcare/wp-content/plugins/revslider/public/assets/assets/dummy.png)
do next is required, Coral states...
![narrative10210b](http://clinicalethics.healthcare/wp-content/plugins/revslider/public/assets/assets/dummy.png)
During the examination Jack appears distressed when seeing the needle for the blood test, subsequently becoming uncooperative and refusing to provide his arm. Coral says it is the dehydration which is making him non-compliant and she will consent to the blood test on his behalf. When informed that a discussion with the staff specialist about what to do next is required, Coral states “I know what he needs! My cousin is a lawyer, and if any harm comes to my father from delays in treatment, we’ll sue the hospital”.
Consent can be understood as permission to intervene. Consent is ethically or legally valid when the person giving consent has capacity to understand information, gives consent freely and voluntarily, for a specific purpose, and that any consent given is based on adequate disclosure of material information by the health practitioner. Consent thus requires:
Elements which enable a valid consent:
- Competence
- Voluntariness
Elements which inform:
- Disclosure of information
- Understanding of information
Elements which enact consent
- Decision (including specificity)
- Authorisation (of the chosen treatment plan)
Reference for this framing: Kerridge, I., Lowe, M., & Stewart, C. (2013). Ethics and law for the health professions (4th ed.). Sydney: Federation Press.
What do you do next?
Refer to medico-legal
There is no indication for this at this time.
This is a routine case that can be managed locally – Explore another option
Take the blood samples
Consent is required for this. If Jack lacks the capacity to consent, then Coral, as his unpaid carer, may be a ‘person responsible’ who can provide substitute consent on his behalf. However, Jack’s capacity must be assessed first. Furthermore, a consent from a person responsible will not be valid if Jack is objecting to having blood taken – Explore another option
Speak to Jack about his wishes and assess his decision-making capacity
This must be the first priority.
In a busy hospital, especially with assertive family members present, this can often be overlooked – Explore another option
Don’t take the blood samples until Jack consents
If Jack has capacity to consent then this is the only course of action available.
However, if Jack lacks capacity to consent, alternative avenues of consent may be required to avoid unnecessary delays in treatment. – Explore another option
Refer Jack to psychiatrist or geriatrician to assess his decision-making capacity
There is no indication for this at this time.
This is a routine case that can be managed locally – Explore another option
In the following video Professor Cameron Stewart of the Sydney Law School briefly discusses overriding patient refusal of medical treatment.
Prof Cameron Stewart
“What ethical considerations must be considered when overriding patient refusal of treatment?”