School Papers

To of B’s disability. (Equality Act). I have

To
conclude from this module, (4004) I have expanded my knowledge on the principle
and laws to do with consent. There are many laws and regulations put into
practice to ensure a patient is given the best service possible. I am also now
aware of the different acts that are linked in with consent. I have learnt how
to communicate with dementia patients, also how to approach a situation where
someone refuses treatment, and how to deal with it. Furthermore, I have gained
awareness on the ethical and legal issues surrounding consent. overall the key
issue is whether a patient has the capacity to consent. Are they competent
enough to make a well enough decision?

 

To
sum up this essay, patients with dementia should not be treated any differently
to patients without dementia. They should also be treated in a way where Beneficence
and Non-maleficence is considered before examining them. Assuming a patient is
incapable of consenting to an examination is discriminating. A person (A) discriminates against a disabled person (B) if
— (a)A treats B unfavorably
because of something arising in consequence of B’s disability. (Equality Act). I
have leant to ‘understand the need to respect and uphold the rights, dignity,
values, and autonomy of service users including their role in the diagnostic
and therapeutic process and in maintaining health and wellbeing’ (HCPC)

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In
relation to consent and these SoR principles Radiographers should not assume
that a patient is incapable of deciding. The Radiographers should firstly
support the patient in helping them to decide. They could also ask the patients
carers to help, however they cannot give consent on behalf of the patient. If,
however, they are still not able to consent; acting in the best interest would
be the next step.

There
are 5 key principles in the SoR to do with capacity. Number 1 is ‘presumption
of capacity’ – every adult has the right to make his/her own decision and must
have capacity to do so’. A patient with dementia, shouldn’t be assumed
incompetent unless proven otherwise. Number 2 is the ‘right for individuals to be
supported make their own decisions’ – patients should be given all the help
possible before anyone concludes that they are incompetent to consent. Number 4
is ‘best interest’ – anything done on behalf of someone without capacity must
be in their best interests. Number 5 is the ‘least restrictive intervention’ –
anything done on behalf of someone should be the least restrictive of their
basic rights and freedoms.

Communication can be divided into 2 aspects: Verbal
& Non-verbal. Verbal communication is the use of sound and words,
expressing oneself by talking. Non-verbal communication is expressing oneself
with actions, hand gestures, eye contact and body movement. When dealing with
patients with dementia, the imaging professional should attempt to use both
Verbal and Non-verbal communication with the patient. This is because due to
the condition the patient may find it difficult to process what the
Radiographer is trying to say. If this was to happen then sometimes the patient
could get frustrated and angry, which would cause miscommunication between the
conversation. Therefore, prior imaging a patient the Radiographer should
explain the process. The HCPC (8.1) also indicates that Radiographers should ‘be
able to demonstrate effective and appropriate verbal and non-verbal skills in
communicating information, advice, instruction and professional opinion to
service users, colleagues and others’. (HCPC)

To communicate with a dementia patient the imaging
professional should get the patients attention as efficiently as they can. They
should try and avoid loud noise and should limit any distractions. For the
patient to fully understand them. The professional should also state the
message as clearly as possible, they should use simple language and be straight
to the point. They should speak slowly and clearly so the patient understands
them. The imaging professional should ask closed questions, as it is easier for
the patient to answer. They should give time for the patient to answer the
question properly. Reassuring the patient, and explaining the procedure the
patient will be less conscious and worried. 

Communication with dementia patients can be quite
difficult, as dementia causes memory loss. This means that the imaging
professionals working with the dementia patient should be patient and
understanding. Throughout the whole procedure the professionals should try and
make conversation with the patient and reassure them that they are safe. If the
patient is calm and relaxed, then the procedure will go well. If the
professional does not have effective communication skills, then the dementia
patient may sometimes get confused which would lead to them panicking. Therefore,
ensuring the patient is at peace will making the process easier for both the
patient and the professional.

Justice is the principle of fairness. However, for an
imaging professional, it means that a correct/suitable procedure should be
carried out after consent. Patients with dementia should not be treated
differently or unfairly, due to their condition. This implies, that the same
equipment should be used for a patient with dementia as well as someone
without.

Beneficence is the performance of good acts and
preventing evil. This ethical issue requires professionals to do good to
patients and prevent any harm. Beneficence is similar to making a ‘best
interest decision’. It is done for the benefit of others. This connects with
patients with dementia as professionals need to apply beneficence when they are
dealing/examining the patient. Non-maleficence on the other hand is avoiding
evil. The professionals weigh out the risks and benefits and consider which one
is more beneficial to the patient. An imaging professional should firstly
contemplate, whether an x-ray image should be taken, if it is beneficial to the
patient, whether the benefits outweigh the risks. As the professional should be
apply Non-maleficence before any examination. The difference between
Beneficence and Non-maleficence is that the stronger ethic is Non-maleficence.
This is because the imaging professional is avoiding harm to the patient
whereas Beneficence – the performance of good is weaker. A decision should be
made after considering both Beneficence and Non-maleficence.

There are also ethical issues surrounding capacity
to consent. The 4 issues I will be talking about are: Autonomy, Beneficence,
Non-maleficence and Justice. Autonomy is defined as when ‘one human person,
precisely as a human person, does not have the authority and should not have
power over another human person’. Autonomy links in with consent as it is a
must that the patients’ autonomy is considered, before a procedure like
imaging. Autonomy is a way of receiving an informed consent off a patient.
Imaging professionals should be efficient in explaining the facts and
statistics to inform the patient on the risks and benefits.

‘Familiarity with professional codes of ethics and understanding of ethical
schools of thought, patient-professional interaction models, and patients’
rights prepares imaging professionals to address future ethical dilemmas. When
difficult situations arise, they have already thought through the various
courses of action and can respond in keeping with their personal standards of
ethics’ (Ethical and legal issues for imaging professionals). Doreen is trying
to imply that the professionals should be aware of the different laws and
ethics whilst imaging a patient, because if they were ever in a difficult situation
then they would know how to deal with the patient.  

‘Be able to exercise a professional duty of care’
(HCPC), acting in a professional way with patients is very important. Especially
when these patients suffer from dementia and need that extra assistance, the Radiographers
should be professional in the way they treat the patient.  

The Human Right Act (1998) lets a person define
their rights to treat people equally, fairly and with respect. The articles in
the Act make sure every individual is not discriminated due to their opinion.
Article 2 is all about ‘right to life’. This proves that nobody can try to end
a life, it protects your right to life. This interlinks with capacity to
consent, because if a patient was incompetent to decide on their own then this
Article will help professionals when making an overall decision. Article 3
protects someone from torture, mentally or physically. Article 4 talks about
liberty. Both Articles 3 & 4 indicate that an individual cannot be forced
into making a decision which would affect them. They have full right to making
their own. Article 10 ‘protects your right to hold your own opinions’ (freedom
of expression). Patients can refuse treatment, even if it is going against what
a professional would recommend. This leads onto Article 14, which is on discrimination,
an individual’s decision cannot be discriminated upon, as everyone is qualified
for their own demeanour and choices. Nevertheless, all these Articles come down
to whether the patient is competent or not.

The Duty Of Health (DOH) – 12 points of consent,
also indicates different scenarios/types on when consent is needed. The definition
of consent is giving permission for something to happen. The reason as to why
informed consent is so significant is because the patient should be aware of
all the risks and benefits that would be arising from the type of treatment they
will be having. In this case imaging a patient, has risks as well as benefits. Therefore,
the patient has full right to be informed on all the possible factors. One of
the points mentions that ‘adults are always assumed to be competent unless
demonstrated otherwise’. This links in with The Mental Capacity Act when
‘assuming capacity’. Hence the radiographer should not assume that the dementia
patient will be unable to give consent. The consent should be valid. This means
the patient should be given ‘sufficient information before they can decide
whether to give their consent’. If the patient is not given the full detail on
the procedure, then the consent would not be fully validated. It is mentioned
in the points that ‘competent adult patients are entitled to refuse treatment,
even where it would clearly benefit their health’. This proves that patients
can refuse to treatment, and healthcare professionals should accept their
decision, even if it is not favouring them. Furthermore, if a patient is
incompetent then no one can give consent on behalf of them, as they don’t have
the authority to. If an incompetent adult has indicated in the past, that they
would refuse this certain type of treatment, then the professional should abide
by the refusal and respect their decision.

Radiographers and healthcare scientists work in an
environment where dementia patients are regular patients. Even though this is
the case, Principle 1 in the Mental Capacity Act, explains that you should not
assume capacity. This implies not assuming something about a patient before you
have met. Assuming they have no ability to agree because of their therapeutic
condition or incapacity, even before the examination, is discriminating (Equality
Act). This then leads onto Principle 2, ‘individuals supported to make their
own decisions’. Professionals are encouraged to help/assist patients with
dementia making their own individual decisions. Healthcare professional need to
make sure they don’t make the decision for them, however support the patient in
making their own. If after these 2 steps, the patient makes an unwise decision
(principle 3), radiographers should respect their decision, even if it is
something that is not beneficial. The patients’ values and beliefs should be
accepted by the radiographer as everyone is entitled to their own opinion. This
connects to the Human Right Act Article 10 – where ‘freedom of expression’ is
explained. Everyone has the right to freedom of expression. Principle 4 is all
about ‘best interest’ –  this is
considering the patients best interests and then making an overall decision on
that. When making a best interest decision the healthcare professional should
speak with the relatives before beginning any procedures. Under the HCPC (2.1) it is stated that
Radiographers must ‘understand the need to act in the best interests of
service users at all times’.  The final Principle
(5) is the ‘less restrictive option’. This is when someone makes the decision
on behalf of the patient who lacks the capacity to make their own decision. The
person making the decision must consider the patient’s rights and beliefs prior
in deciding with anything. Overall it comes down to whether the patient has
capacity to consent or not.

Working
as a healthcare professional means you deal with patients with dementia.
Dealing with such patients can be very troublesome and hard. In this way, a few
procedures are placed to carry certain techniques like Imaging. Patients with
dementia do not always have the capacity to consent. However, some patients are
still able to give consent. This all comes down to autonomy – where everyone is
entitled to make their own decisions. ‘Autonomy is the concept that patients are to be treated as individuals and
informed about procedures to facilitate appropriate decisions’. This concept
relates to the DOH – 12 points of consent. Point 1 notices ‘before you examine,
treat or care for competent adult patients you must obtain their consent.’ This
clearly proves the significance of valid/legitimate consent. A competent patient
means ‘having the necessary ability, knowledge, or skill
to do something successfully.’ If the patient has the capacity to consent, the
radiographer should accept the decision of the patient, whether it is
beneficial or not to the patient. The Human Right Act Article 10 portrays the
freedom of expression – which indicates the right to your own opinion freely.
Healthcare professionals should respect this off the patients and not take a
blind eye at it.  

Firstly,
before settling on a choice in a matter whether a patient has the ability to assent.
The patient should be able to ought to have the capacity to comprehend the
choice to be made and the data given. Has the patient been given all
information required? Thereafter the patient should be able to retain the
information. They should be given enough time to make a decision, as they have
full right to. Thirdly the patient should utilize that data to settle on an official
choice – they should weigh out the pros and cons, and then conclude from that.
Lastly, the patient should communicate their decision with a healthcare
professional. If a person cannot give consent at that certain time as they may
be unconscious for e.g. then the professional should treat them as though they
lack capacity.

Consenting
to procedures/treatments implies the patient is educated, of the advantages and
dangers of the procedure. However, some patients do not have the capacity to
consent. These patients incorporate individuals with dementia. Dementia is a
condition where somebody endures with side effects, for example, memory
misfortune and find it difficult when thinking. Due to the confusion
influencing the mind and influencing the way a man would think – there are
rules and regulations put into place to conclude whether a patient is competent
to make a suitable decision for themselves. Do they have the capacity to
consent? Consent can be determined in 4 ways: 1) Communication 2) Understanding
3) Appreciation 4) Realisation/Reasoning. These 4 components assess the
capacity of an individual.

In
this essay I will be discussing the legal, ethical, professional and communication
issues within imaging a patient with dementia. The aim of the essay is to take
an insight on all the possible factors when dealing with a dementia patient,
and how regulations are put into place for situations like these.

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I'm Rhonda!

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