Page 105 - Registrar Orientation Manual 2016

Document reference:
1969
Effective date:
30 Mar 2010
Expiry date:
01 Jun 2013
Page:
13 of 24
Title:
Informed consent
Type:
Policy
Version:
03
Authorising initials:
5.4. Advance Directive
5.5. Patient refusal to consent to
treatment
 If there is no one with a legal right to give consent on behalf of the incompetent patient, then Right 7(4) of the Code applies.
"Where a consumer is not competent to make an informed choice and give informed consent, and no person entitled to consent on behalf of the patient is available, the health professional (provider) may provide services where:
a. it is in the best interests of the patient and
b. reasonable steps have been taken to ascertain the views of the
patient and
c. either:
i. if the patient's views have been ascertained and, having regard to those views, the health professional believes on reasonable grounds that the provision of services is consistent with the informed choice the patient would make if he or she were competent; or
ii. if the patient's views have not been ascertained, the health professional takes into account the views of other suitable persons who are interested in the welfare of the patient and are available to advise the health professional." (This would include such people as the patient's permanent caregivers, his or her GP, next of kin and whānau.)
 Appendix B, 7 provides a flowchart for use of Right 7(4).
 One way of knowing what the patient would have wished, is through
the provision of an advance directive.
 An “advance directive” is a written or oral directive by which a patient can make choices about possible future healthcare procedures. They are intended to become effective only when the patient is not competent to provide informed consent.
 If you are faced with an advance directive (written or oral) and it pertains to the patient’s proposed treatment, please seek legal advice as the risks associated with incorrectly applying an advance directive can be significant.
 When a competent patient does not consent to all or part of treatment staff shall:
- explain possible risks and consequences involved in refusing treatment
- provide relevant health information, including information on continuing care requirements
- inform the patient’s responsible clinician of the patient’s refusal to consent to treatment
- reassure the patient that the decision to refuse treatment will not affect their access to future treatment
- with permission of the patient or under Section 7A of the Mental Health (Compulsory Assessment and Treatment) Act 1992 involve family / whānau, support person/s and / or advocates
- contact the Mental Health Crisis Assessment and Treatment