Saturday, 18 August 2018

Consent to treatment is the principle that a person

must give permission before they receive any type of medical treatment, test or examination.

This must be done on the basis of an explanation by a clinician.

Consent from a patient is needed regardless of the procedure, whether it's a physical examination, organ donation or something else.

The principle of consent is an important part of medical ethics and the international human rights law.

Defining consent
For consent to be valid, it must be voluntary and informed, and the person consenting must have the capacity to make the decision.

These terms are explained below:

voluntary – the decision to either consent or not to consent to treatment must be made by the person themselves, and must not be influenced by pressure from medical staff, friends or family
informed – the person must be given all of the information in terms of what the treatment involves, including the benefits and risks, whether there are reasonable alternative treatments, and what will happen if treatment doesn't go ahead
capacity – the person must be capable of giving consent, which means they understand the information given to them and they can use it to make an informed decision
If an adult has the capacity to make a voluntary and informed decision to consent to or refuse a particular treatment, their decision must be respected.

This is still the case even if refusing treatment would result in their death, or the death of their unborn child.

If a person doesn't have the capacity to make a decision about their treatment, and they haven't appointed a lasting power of attorney (LPA), the healthcare professionals treating them can go ahead and give treatment if they believe it's in the person's best interests.

But clinicians must take reasonable steps to seek advice from the patient’s friends or relatives before making these decisions.

Read more about assessing the capacity to consent, which explains what someone can do if they know their capacity to consent may be affected in the future.

How consent is given
Consent can be given:

verbally – for example, by saying they're happy to have an X-ray
in writing – for example, by signing a consent form for surgery
Someone could also give non-verbal consent, as long as they understand the treatment or examination about to take place – for example, holding out an arm for a blood test.

Consent should be given to the healthcare professional directly responsible for the person's current treatment, such as:

a nurse arranging a blood test
a GP prescribing new medication
a surgeon planning an operation
If someone is going to have a major medical procedure, such as an operation, their consent should ideally be secured well in advance, so they have plenty of time to obtain information about the procedure and ask questions.

If they change their mind at any point before the procedure, the person is entitled to withdraw their previous consent.

Consent from children and young people
If they're able to, consent is usually given by patients themselves.

However, someone with parental responsibility may need to give consent for a child up to the age of 16 to have treatment.

Read more about the rules of consent applying to children and young people

When consent isn't needed
There are a few exceptions when treatment may be able to go ahead without the person's consent, even if they're capable of giving their permission.

It may not be necessary to obtain consent if a person:

requires emergency treatment to save their life, but they're incapacitated (for example, they're unconscious) – the reasons why treatment was necessary should be fully explained once they've recovered
immediately requires an additional emergency procedure during an operation – there has to be a clear medical reason why it would be unsafe to wait to obtain consent, and it can't be simply for convenience
with a severe mental health condition, such as schizophrenia, bipolar disorder or dementia, lacks the capacity to consent to the treatment of their mental health (under the Mental Health Act 1983) – in these cases, treatment for unrelated physical conditions still requires consent, which the patient may be able to provide, despite their mental illness
requires hospital treatment for a severe mental health condition, but self-harmed or attempted suicide while competent and is refusing treatment (under the Mental Health Act 1983) – the person's nearest relative or an approved social worker must make an application for the person to be forcibly kept in hospital, and two doctors must assess the person's condition
is a risk to public health as a result of rabies, cholera or tuberculosis (TB)
is severely ill and living in unhygienic conditions (under the National Assistance Act 1948) – a person who is severely ill or infirm and is living in unsanitary conditions can be taken to a place of care without their consent
Consent and life-sustaining treatments
A person may be being kept alive with supportive treatments – such as lung ventilation – without having made an advance decision, which outlines the care they would refuse to receive.

In these cases, a decision aboConstipation is common and it affects people of all ages. You can usually treat it at home with simple changes to your diet and lifestyle.

Check if it's constipation
It’s likely to be constipation if:

you or your child haven't had a poo at least 3 times in a week
the poo is often difficult to push out and larger than usual
the poo is often dry, hard or lumpy
However, it's not unusual for a breastfeeding baby to go a week without having a poo.

You may also have a stomach ache and feel bloated or sick.

Things to look out for in babies and toddlers include:

a lack of energy
being irritable, angry or unhappy
soiling their clothes
What causes constipation
Constipation in adults has many possible causes. Sometimes there is no obvious reason.

The most common causes include:

not eating enough fibre – such as fruit, vegetables and cereals
not drinking enough fluids
not exercising or being less active
often ignoring the urge to go to the toilet
changing your diet or daily routine
stress, anxiety or depression
a side effect of medication
Constipation is also common during pregnancy and for 6 weeks after giving birth.

In much rarer cases, constipation may be caused by a medical condition.

How you can treat constipation yourself
How to treat constipation
Play Video
Media last reviewed: 20/07/2017

Media review due: 20/07/2020

Simple changes to your diet and lifestyle can help treat constipation. It's safe to try these simple measures when you're pregnant.

You may notice a difference within a few days. Sometimes it takes a few weeks before your symptoms improve.

Make changes to your diet
To make your poo softer and easier to pass:

drink plenty of fluids and avoid alcohol
increase the fibre in your diet
add some wheat bran, oats or linseed to your diet
Increase your activity
A daily walk or run can help you to poo more regularly.

Getting started with exercise
Getting active with a disability or long-term condition
Exercise during pregnancy
Improve your toilet routine
Keep to a regular time and place and give yourself plenty of time to use the toilet. Don't delay if you feel the urge to poo.

To make it easier to poo, try resting your feet on a low stool while going to the toilet. If possible, raise your knees above your hips.

Babies and toddlers: what causes constipation
Constipation in babies and toddlers has many possible causes. Sometimes there is no obvious reason.

It usually happens when your child:

first starts taking formula or processed foods as a baby
is being potty trained as a toddler
has just started school
The most common causes include:

not eating enough fibre – such as fruit, vegetables and cereals
not drinking enough fluids
overfeeding – including giving babies too much milk
fear or anxiety about using the toilet – at home or at school
poor potty training – such as feeling pressured or being regularly interrupted
In much rarer cases, constipation in babies and toddlers may be caused by a medical condition.

Babies and toddlers: treating constipation
Simple changes to your child's diet and potty training can help treat constipation.

You may notice a difference within a few days. Sometimes it takes a few weeks before their symptoms improve.

Make changes to your child's diet
Give your baby extra water between their normal feeds if they haven't started to eat solid food yet. If you're using formula milk, don't add more water to the mixture.

Try gently moving your baby's legs in a bicycling motion or carefully massaging their tummy to help stimulate their bowels.

Give older children plenty of fluids and encourage them to eat fruit. Chop or purée it if it's easier for them to eat. The best fruits for constipation include apples, grapes, pears and strawberries.

Don't force your child to eat as this can make mealtimes stressful.

What to feed young children

Helping your child with potty training
Some children feel anxious or stressed about using the toilet. This can cause them to hold in their poo and lead to constipation.

This usually happens during potty training or if their usual toilet routine has changed. For example, after moving house or starting nursery.

Give your child plenty of time to use the toilet while they are still learning. Encourage them when they do use the toilet. Some parents find a reward chart works.

Potty training tips

A pharmacist can help with constipation
Speak to a pharmacist if diet and lifestyle changes aren't helping. They can suggest a suitable laxative. These are medicines that help you poo more regularly.

Most laxatives work within 3 days. They should only be used for a short time.

Laxatives are not recommended for children unless they are prescribed by a GP.

Different types of laxatives and how they work.

Find a pharmacy

See a GP if you or your child:
are not improving with treatment
are regularly constipated and it lasts a long time
are bloated and it lasts a long time
have blood in your poo
have unexpectedly lost weight (or a child has not grown or gained weight)
feel very tired all the time
Speak to the GP before you stop taking any prescribed medication.

Complications of long-term constipation
Long-term constipation can lead to faecal impaction. This is where poo has built up in your rectum. The main symptom is diarrhoea after a long bout of constipation.

Faecal impaction may be treated with:

stronger laxatives – prescribed by a GP
a suppository – medicine you place in your bottom
a mini enema – where fluid is passed through your bottom, into your bowel
a doctor removing some of the poo
ut continuing or stopping treatment needs to be made based on what that person's best interests are believed to be.

To help reach a decision, the healthcare professionals responsible for the person’s care should discuss the issue with the relatives and friends of the person receiving the treatment.

They should consider, among other things:

what the person's quality of life will be if treatment is continued
how long the person may live if treatment is continued
whether there's any chance of the person recovering
Treatment can be withdrawn if there's an agreement that continuing treatment isn't in the person's best interests.

The case will be referred to the courts before further action is taken if:

an agreement can't be reached
a decision has to be made on whether to withdraw treatment from someone who has been in a state of impaired consciousness for a long time (usually at least 12 months)
It's important to note the difference between withdrawing a person's life support and taking a deliberate action to make them die. For example, injecting a lethal drug would illegal.

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