Legal Frameworks, Consent, and Capacity 1 Flashcards

A 15-year-old girl attends a sexual health clinic requesting contraceptive advice without her parents' knowledge. The nurse assesses that she fully understands the implications. Which legal principle allows the nurse to provide treatment without parental consent?

Answer: Gillick competence

Gillick competence is the overarching legal principle established in Gillick v West Norfolk (1985) that a child under 16 can consent to treatment if they have sufficient maturity and understanding. The Fraser Guidelines are a narrower set of criteria specifically for contraceptive advice and are derived from this broader principle.

A 79-year-old woman with severe dementia is living in a care home. Staff prevent her from leaving the building daily because they believe it keeps her safe. She lacks capacity to consent to this restriction. What is the FIRST legal step staff must take to ensure this is lawfully authorised?

Answer: Request a Deprivation of Liberty Safeguards (DoLS) authorisation from the supervisory body

Where a person who lacks capacity is deprived of their liberty in a care home or hospital, the Deprivation of Liberty Safeguards (DoLS) under the Mental Capacity Act 2005 (Schedule A1) require the managing authority to apply to the supervisory body for authorisation before or as soon as possible after the deprivation begins. Documentation and family notification are good practice but do not legally authorise the restriction.

A patient who lacks capacity has a registered Lasting Power of Attorney (LPA) for Property and Financial Affairs held by their son. The son attends the ward and states he wishes to consent to his father's upcoming surgical procedure. What should the nurse advise?

Answer: A Property and Financial Affairs LPA does not cover healthcare decisions; only a Health and Welfare LPA grants this authority

There are two types of LPA under the Mental Capacity Act 2005: Property and Financial Affairs, and Health and Welfare. Only a Health and Welfare LPA, when registered and activated, grants an attorney the authority to make decisions about medical treatment. A Property and Financial Affairs LPA is strictly limited to financial matters.

Under the Mental Health Act 1983, what is the correct distinction between a Section 2 and a Section 3 detention?

Answer: Section 2 authorises assessment for up to 28 days; Section 3 authorises treatment for up to six months

Under the Mental Health Act 1983, Section 2 detains a patient for assessment (and any necessary treatment) for up to 28 days and cannot be renewed. Section 3 detains a patient for treatment for up to six months and can be renewed. Both require recommendations from two registered medical practitioners and an application by an Approved Mental Health Professional or nearest relative.

When making a best interests decision for an adult who lacks capacity under the Mental Capacity Act 2005, which approach is explicitly prohibited by the Act?

Answer: Basing the decision solely on the person's age, appearance, or diagnosis

Section 4(1) of the Mental Capacity Act 2005 explicitly states that a person must not make a best interests determination merely on the basis of the person's age, appearance, a condition they have, or an aspect of their behaviour. The Act requires a holistic approach that includes past wishes, values, and consultation with relevant others.

A 4-year-old child is admitted requiring urgent surgery. His parents are not married and were never in a formal relationship. His mother is present and consents. His biological father, whose name does not appear on the birth certificate, also arrives and objects to the procedure. Whose decision is legally determinative under the Children Act 1989?

Answer: The mother's consent is sufficient as the father does not hold parental responsibility

Under the Children Act 1989, an unmarried father does not automatically acquire parental responsibility. Parental responsibility is obtained by being named on the birth certificate (for registrations after 1 December 2003 in England and Wales), entering a Parental Responsibility Agreement, or obtaining a court order. As the father is not on the birth certificate, he has no parental responsibility, and the mother's consent alone is legally sufficient.