Welcome back!
Today we are talking about the three C’s of medical ethics and law which is very important to know for your medical interviews!
I have been super busy this month releasing my interview live series on Instagram which you can check out below! Thanks for being patient with the blog content this year as it is a very busy and strange year for us all!
Furthermore, all of this content came from the live stream with the wonderful Irene the medic, so go check out her page!
What are the three C’s and why are they important?
- Consent
- Capacity
- competence
These are super fundamental to the way patient care works in this country. Before any other decisions can be made about healthcare, we tend to look at the three C’s as principles which without them we would be living in a different type of world.
For instance, there would be no way to withdraw from procedures! Moreover, they may not even ask you to consent to the procedure.
Hopefully that shows how incredibly important these C’s are!
Three C’s: (Informed) Consent:
Consent is where the patient gives permission to the clinician to be provided with medical attention.
Firstly, patient consent must be voluntary, meaning the patients should be fully aware and informed and that they are not coerced into making a decision.
Secondly, Consent in medicine must be informed which means patients must be aware of all the benefits and risks of the medical treatment. Furthermore, Voluntary consent can also be withdrawn at any time.
Consent can be:
- Written
- verbal
- implied.
Three C’s: Capacity:
Governed by the mental capacity act of 2005.
It is assessed by being able to:
- Understand information
- Retain information.
- Be able to weigh up risks, benefits and alternatives.
- Be able to communicate a reasoned decision.
The age of default capacity in the UK is 18.
However, In Scotland, ‘The adults with incapacity act’ govern capacity. It specifically states that the patient must be able to make a sustained decision.
Three C’s: Competence:
Competence is having the quality to make the decision.
In the UK default competence starts at 18, and in Scotland, it is 16.
Gillick competence.
In the 80s Victoria Gillick, English activist went to the court to prevent her local authority providing contraception, or advice on sexual health to children under the age of 16 without parental consent.
This resulted in new laws where minors under the age of 16 are able to consent to their own treatment.
This is the language used in the case:
“…whether or not a child is capable of giving the necessary consent will depend on the child’s maturity and understanding and the nature of the consent required. The child must be capable of making a reasonable assessment of the advantages and disadvantages of the treatment proposed, so the consent, if given, can be properly and fairly described as true consent”
(Gillick v West Norfolk, 1984).
Gillick competence is governed by the Fraser guidelines for contraceptive and sexual health care.
Some people are of the legal age of competence at 18, but may not have the capacity, due to their situation for example having dementia etc.
Let’s apply it!
What would you do in a situation with a minor aged 14 who wishes to obtain contraceptive pills from you, the GP?
- Do they have capacity?
- Do they have Gillick competence?
- Have you asked relevant questions about the situation to ensure that this is her voluntary consent to receiving treatment/ (At this age, you must be careful of coercion and grooming)
So, What happens if the patient is 18?
- You know they are legally competent
- Ensure they have the capacity( do not have a debilitating mental illness or are under the influence etc)
So, what happens with an elderly patient with dementia, who has consented to a knee surgery 6 months ago but now is having a lapse of memory and cannot remember giving informed consent?
- Capacity must be reassessed.
- Consent must be given again unless he can remember giving that consent.
- The man is of the age of legal competence but doe not appear to have the capacity.
Wrapping up:
To conclude, I hope this has been really helpful and you gave learnt lots about the three c’s of ethics and Law ready for your interviews.
All of the content of this post has stemmed from my Instagram live stream with irene the medic so go and give her a follow!
Thank you all for being patient and supportive with me during this busy, busy year!
Finally, Make sure you subscribe to my email list to keep up to date with what’s happenin’.