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Richard Griffith, Senior Lecturer in Health Law at Swansea University, discusses the importance of consent in nursing and outlines the key elements for ensuring the patient has given valid consent before providing treatment [ABSTRACT FROM AUTHOR]

The article offers information on negligence in nursing care, highlighting the legal elements required to establish a negligence claim. Topics include the duty of care owed by nurses to patients, the standard of care expected in nursing practice, and the legal principles governing negligence claims, including the rule in Bolitho and a case example regarding patient assessment.

Background: Informed consent is required for participation in clinical trials, however trials involving adults who lack capacity to consent require different enrolment processes. A family member usually acts as a proxy to make a decision based on the patient's 'presumed will', but these decisions can be challenging and families may experience an emotional and decisional burden. Decisions made on behalf of others are conceptually different from those made for ourselves. Innovations have been developed to improve informed consent processes for research, including a number of decision aids, however there are no interventions for proxies who are faced with more complex decisions. This article outlines the development of a novel decision aid to support families making decisions about research participation on behalf of an adult who lacks capacity to consent.Methods: Decision support interventions should be developed using rigorous and evidence-based methods. This intervention was developed using MRC guidance for the development of complex interventions, and a conceptual framework for the development and evaluation of decision aids for people considering taking part in a clinical trial. The intervention was informed by a systematic review and analysis of existing information provision. Previous qualitative research with families who acted as proxies enabled the development of a theoretical framework to underpin the intervention. The intervention was iteratively developed with the involvement of lay advisors and relevant stakeholders.Results: Previous research, theoretical frameworks, and decision aid development frameworks were used to identify and develop the intervention components. The decision aid includes information about the proxy's role and utilises a values clarification exercise and decision support methods to enable a more informed and better-quality decision. Stakeholders, including those representing implementers and receivers of the intervention, contributed to the design and comprehensibility of the decision aid to ensure that it would be acceptable for use.Conclusions: Frameworks for the development of decision aids for people considering participating in a clinical trial can be used to develop interventions for family members acting as proxy decision-makers. The decision support tool is acceptable to users. Feasibility testing and outcome measure development is required prior to any evaluation of its effectiveness. [ABSTRACT FROM AUTHOR]

The article examines legal cases that set out the fundamental elements to be met for a successful negligence action resulting in the award of compensation such as the patient was owed a duty of care by the nurse, there was a breach of that duty of care, which fell below the required standard, and the breach of duty caused loss or harm recognised by the courts. It discusses different cases including Hatcher v Black, Burke v GMC, and McCulloch v Forth Valley Health Board.

Background Research into dementia and other conditions connected with cognitive impairments is essential but conducting research with populations who lack capacity to provide consent involves a number of ethical, legal and practical challenges. In England and Wales, family members can act as a consultee or legal representative on behalf of someone who lacks capacity. However, there is a paucity of research about how family members make decisions concerning research participation. Objective To explore family members' experiences of proxy decision-making for research. Understanding how proxy decisions are made could lead to interventions to support greater inclusion of individuals in research who have impaired decision-making capacity. Methods Semi-structured interviews were conducted with a purposive sample of 17 family members who had experience as a proxy for making decisions about participation in research, including those who had agreed to participation and those who declined. Thematic analysis was used to examine experiences and generate findings for research practice and to develop future supportive interventions. Results Proxy decision-making is highly contextualised. Proxies balance a number of factors when deciding about research participation, including the person's values and preferences, within the specific context of the study, and the practicalities of being involved. Proxies use these factors to construct a decision that is authentic to the person they care for. Conclusions Proxy decision-making for research is a complex process with inter-woven layers of decision-making. Decisions can be problematic for some proxies who may benefit from decision support to make an informed decision about research participation on behalf of a family member. [ABSTRACT FROM AUTHOR]

Richard Griffith, Senior Lecturer in Health Law at Swansea University, considers the limits to personal autonomy using body modification to illustrate the legal principles of consent [ABSTRACT FROM AUTHOR]

Richard Griffith, Senior Lecturer in Health Law at Swansea University, considers the importance of accessible information when obtaining consent from patients [ABSTRACT FROM AUTHOR]

Objective: To examine health and social care professionals' understanding of the legislation governing research involving adults lacking mental capacity in England and Wales.Methods: A cross-sectional online survey was conducted using a series of vignettes. Participants were asked to select the legally authorised decision-maker in each scenario and provide supporting reasons. Responses were compared with existing legal frameworks and analysed according to their level of concordance.Results: One hundred and twenty-seven professionals participated. Levels of discordance between responses and the legal frameworks were high across all five scenarios (76%-82%). Nearly half of the participants (46%) provided responses that were discordant in all scenarios. Only two participants (2%) provided concordant responses across all five scenarios.Discussion: Participants demonstrated a lack of knowledge about the legal frameworks, the locus of authority and the legal basis for decision-making. The findings raise concern about the accessibility of research for those who lack capacity, the ability to conduct research involving such groups and the impact on the evidence base for their care.Conclusion: This is the first study to examine health and social care professionals' knowledge and understanding of the dual legal frameworks in the UK. Health and social care professionals' understanding and attitudes towards research involving adults with incapacity may warrant further in-depth exploration. The findings from this survey suggest that greater training and education is required. [ABSTRACT FROM AUTHOR]

An NHS trust recently agreed a £45 000 settlement with the family of a woman who was given treatment contrary to her advance decision for some 2 years before she died. In this article, Richard Griffith discusses the requirements for a valid applicable advance decision to refuse treatment and a district nurse's duty to record and give effect to the wishes expressed within it. [ABSTRACT FROM AUTHOR]

Richard Griffith, Senior Lecturer in Health Law at Swansea University, discusses this provision under the Mental Health Act 1983, to include physical disorders that are increasingly remote from the person's mental disorder [ABSTRACT FROM AUTHOR]

The article presents the discussion on consent establishing the propriety of the treatment given by nurses and providing a defence to an allegation of unlawful touching. Topics include another person having parental responsibilities showing a right to consent to treatment of the minor; and proper balance between paternalism and patient autonomy altering in favour of minors attaining the age of 16 years.

The Court of Protection is the specialist court that makes decisions in relation to people who lack decision-making capacity. In this article, Richard Griffith considers the powers of the Court of Protection and discusses when it might be necessary for a district nurse to seek an order from the court in relation to the care or treatment of a patient. [ABSTRACT FROM AUTHOR]

The article presents the discussion on concerns over the use of consent for removing a baby into local authority care. Topics include containing no compulsory provisions and no compulsory curtailment of parental responsibility; and refusing the permission for social workers in removing the newborn baby into the care under the Children Act.

District nurses sometimes encounter situations where a patient in need of hospital treatment, or their family, refuses to go. Richard Griffith considers the legal options available to a district nurse who believes their patient should be removed from home and taken to hospital for treatment against their wishes. [ABSTRACT FROM AUTHOR]

The previous article in this law column considered a patient's right to give a real consent before a district nurse could proceed with care and treatment. This article considers the district nurse's rights and responsibilities when considering withdrawing or withholding clinically-assisted nutrition and hydration. It focuses on recent cases in the Court of Protection, M v A Hospital [2017], and High Court, NHS Trust v Mr Y & Mrs Y [2017], and on the need to bring such cases to court before treatment is withdrawn. [ABSTRACT FROM AUTHOR]

Obtaining a real consent is fundamental to the propriety of treatment given by district nurses. Real consent respects patient autonomy and is underpinned by three key elements. In this article, on the principles of patient consent, Richard Griffith outlines the elements of a real consent and the importance of obtaining consent to district nurse practice. [ABSTRACT FROM AUTHOR]

The Declaration of Helsinki requires that health care research takes place with the informed consent of those who participate in the study. This approach upholds the autonomy of the participants, but restricts research to subjects who have decision-making capacity. The Mental Capacity Act 2005 introduced safeguards that enable researchers to investigate the care and treatment of people with incapacity, while protecting this vulnerable patient group. These safeguards allow people who lack decision-making capacity to benefit from research findings. In this article, Richard Griffith outlines the requirements that must be met when district nurses conduct research on subjects who lack decision-making capacity. [ABSTRACT FROM AUTHOR]

Last month's article considered the scope of a district nurse's duty to maintain the confidentiality of patient information under the Nursing and Midwifery Council (NMC) Code, their contract of employment, and the law. This month, Richard Griffith considers the exceptions to these duties and sets out when a district nurse would be justified in disclosing patient information. [ABSTRACT FROM AUTHOR]

Engaging in sexual activity is an essential Human Right protected under article 12 of the European Convention on Human Rights (Council of Europe, 1950) and should be free from state interference. District nurses, however, often express concern over the possibility that adults with acquired brain injury or a learning disability cannot give a real consent to participate in sexual activity and so should be prevented from doing so. In this article Richard Griffith reviews the case law in relation to the capacity to consent to sexual activity. [ABSTRACT FROM AUTHOR]

Decision-making capacity has been described as the 'key to autonomy.' A person who is capable of making a decision about their health care must have that decision respected by a district nurse, as to proceed against the person's wishes would amount to the tort of trespass to the person and, in some cases, a criminal assault. It is essential, therefore, that district nurses are able to assess the decision-making capacity of their patients. [ABSTRACT FROM AUTHOR]

For district nurses obtaining consent is, in most cases, a routine part of delivering care and treatment to patients. In some cases, however, patients will have strong views on the type of treatment they want for their condition and demand it be provided, or equally strong views that they want no treatment and refuse consent. In this article Richard Griffith and Cassam Tengnah consider the legal and professional obligations of district nurses faced with patients who demand or refuse treatment. [ABSTRACT FROM AUTHOR]

Although district nurses provide care and treatment to adults, they also have children on their caseloads from time-to-time. Obtaining consent for the examination and treatment of children is a complex process, where parental responsibility and the developmental concept of Gillick competence become increasingly intertwined as the child matures to adulthood. In this article, the authors consider the requirements for Gillick competence, and highlight the factors district nurses must consider when determining whether a child is competent to give consent to treatment. [ABSTRACT FROM AUTHOR]

With campaigns from the RCN, Nursing Times and Patients' Association promoting dignity and choice in healthcare district nurses need to be aware of the legal principle that lie at the heart of autonomy, consent. In the first of a series of articles on the principles of patient consent Richard Griffith and Cassam Tengnah outline the elements of a valid consent and how important obtaining consent is to the propriety of a district nurse's practice. [ABSTRACT FROM AUTHOR]

The Government wants to see a large rise in the use of adoption as a means of giving children a secure, loving and permanent home. Guidance coming into effect from April calls for a more pragmatic approach to adoption placements, and calls for the active promotion of the adoption process by health and social care professionals. District nurses will encounter people interested in becoming prospective adopters, but who are unsure if their background or lifestyle makes them eligible. It is essential that district nurses have a working understanding of the guidance and provisions of the Adoption and Children Act 2002 to confidently advise others about adoption and clarify any issues raised. [ABSTRACT FROM AUTHOR]

The article discusses the importance of consent in considering professional and legal issues in dental nursing. It highlights the need for patient's valid consent as a general legal and ethical principle before starting the treatment and physical investigation. It stresses the definiton of consent and discusses its various types such as valid, fraudulent and obtaining consent. It expounds the capacity and self-determination, decision making and the Mental Capacity Act in 2005.

In the December 2009 issue of British Journal of Community Nursing Richard Griffith and Cassam Tengnah reviewed the system of consent for non-beating heart organ donation at the centre of the Human Tissue Act 2004. This article considers the benefits and risks of alternative systems of consent being proposed to overcome the United Kingdom's poor organ donation rate that is the worst in Western Europe. [ABSTRACT FROM AUTHOR]

In its State of Care (2015) report the Care Quality Commission once again highlight unsafe management of medicines as a key concern in those care providers that require improvement. Underpinning the poor management of medicines is the unsafe and routine use of covert administration. In this article Richard Griffith looks at the legal and professional obligations for district nurses when they consider advising the use of covert medicines. [ABSTRACT FROM AUTHOR]

NHS Blood and Transplant (NHSBT), the agency responsible for allocating donated organs and maintaining the organ donor register, is considering proceeding with harvesting organs from a registered donor in spite of objections from the deceased's family, in order to raise the number of available organs. District nurses are witness to the need for an increase in the number of donated organs, given the care they provide to those waiting for transplant, and it is essential that district nurses inform this debate. In this article, the author discusses the NHSBT proposal and reviews the law of consent in relation to organ donation. [ABSTRACT FROM AUTHOR]

The debate over how best to seek consent from people for the donation of their organs after death continues unabated. Despite a significant change in approach in seeking consent for donation introduced by the Human Tissue Act 2004 there has been little improvement in the numbers of harvested organs. This has led to calls by various organizations to adopt a more radical approach to consent for organ donation. The Welsh Assembly Government favours a presumed consent approach where a person is assumed to have consented unless they formally opt out, while more recently the Royal College of Physicians has changed its stance and is now calling for a system of mandated choice where a person is compelled to decide if they want to donate their organs. District nurses see first hand the need for an increase in the number of donated organs as they provide the care for those waiting for a transplant and so it is essential that they inform this debate. In the first of a short series of articles the current arrangements for consenting to the donation of organs are considered. [ABSTRACT FROM AUTHOR]

This article uses a real life case study to understand the legal ramifications surrounding practice when dealing with influenza immunization. There are often cases where people with diminished mental capacity refuse immunization. The Mental Capacity Act, 2005 is used as a framework to explain to the practitioner where they stand legally in such situation and how to work safely and competently within the law. [ABSTRACT FROM AUTHOR]

Discusses the legal and professional obligations on district nurses in relation to intimate examinations and treatment in Great Britain. Need of the patient consent to specify the sensitive nature of the intimate procedure; Citations of cases wherein a medical personnel is sentenced for alleged sexual assault; Guideline of the Court of Appeal on the constituent of proper medical treatment.

In his continuing series looking at the law underpinning the standards set out in the revised Code (NMC, 2015), Richard Griffith considers standard 2, which requires district nurses to work in partnership with the people in their care. Although the right to self-determination and the requirement for consent has been a legal principle in health care for over 100 years, its emphasis has been on providing a defence for health professionals rather than promoting partnership in the district nurse-patient relationship. Recent developments in policy and law have begun to herald a change in emphasis from 'health professional knows best' to a more patient-focused approach to decisions about care and treatment. [ABSTRACT FROM AUTHOR]

Richard Griffith, Senior Lecturer in Health Law at Swansea University, considers the legal options available to a nurse who believes their patient should be moved from home to hospital for treatment when the person lacks decision-making capacity to consent to the move [ABSTRACT FROM AUTHOR]

Consent to treatment lies at the heart of autonomous decision making by patients who are entitled to make a free choice about whether to accept or refuse treatment. To help patients arrive at their decision district nurses must ensure that they give sufficient information about the nature and risks inherent in the treatment to allow an informed choice to be made. This article considers how much information regarding risks needs to be disclosed. It discusses how the law requires a different level of disclosure for patients who ask no questions about risks, those who make general enquiries about risks and those who ask specific questions about the risks inherent in treatment. [ABSTRACT FROM AUTHOR]

Richard Griffith, Senior Lecturer in Health Law at Swansea University, discusses the nurse's duty to give patients information about the risks to look out for after treatment or surgery and what to do if an adverse event occurs [ABSTRACT FROM AUTHOR]

Richard Griffith, Senior Lecturer in Health Law at Swansea University, considers the requirements for a valid consent and the limits to that consent in light of a case of a surgeon jailed for performing unnecessary operations [ABSTRACT FROM AUTHOR]

Recently released figures from the Office for National Statistics (2016) show that some 4160 girls under 16 became pregnant in England and Wales in 2014. To manage teenage pregnancies effectively, midwives must be able to assess the child's competence to consent to their maternity care. [ABSTRACT FROM AUTHOR]

The article explores when an informal patient in Great Britain could be deprived of their liberty under the deprivation of liberty safeguards. Particular focus is given to how this relates to those with mental health disorders. Additional topics discussed include the Mental Capacity Act 2005 DoLS authorization, the care of those with ailments including schizophrenia and dementia, and the Mental Health Act of 1983.

Midwives work in partnership with women and sometimes, if the person in a midwife's care is a minor, with their parents. Richard Griffith discusses considerations regarding access to records. [ABSTRACT FROM AUTHOR]

Richard Griffith, Senior Lecturer in Health Law at Swansea University, discusses the circumstances in which a person can be subject to a deprivation of liberty safeguards authorisation in the community [ABSTRACT FROM AUTHOR]

Background: Research involving adults who lack the capacity to provide informed consent can be challenging. In England and Wales there are legal provisions for consulting with others who know the person with impaired capacity. The role of the 'proxy' (or 'surrogate') is to advise researchers about the person's wishes and feelings or to provide consent on the person's behalf for a clinical trial of a medicine. Information about the study is usually provided to the proxy; however, little information is available to proxies about their role, or the appropriate legal and ethical basis for their decision, to help inform their decision-making. The aim of this study was to analyse the written information that is provided to consultees and legal representatives.Methods: Studies including adults lacking capacity to consent which utilised consultees or legal representatives were identified using the UK Clinical Trials Gateway database. A representative sample (n = 30) were randomly selected. Information sheets and other study documents provided to proxies were obtained, and relevant content was extracted. Content analysis was conducted through four stages: decontextualisation of the unit of analysis, recontextualisation, categorisation, and compilation. The data were summarised narratively according to each theme and category.Results: Considerable variation was found in the written information sheets provided to proxies. Most directed proxies to consider the wishes and feelings of the person who lacked capacity and to consult with others during the decision-making process. However, a small number of studies extended the scope of the proxy's role to consider the person's suitability or eligibility for the study. Particular discrepancies were found in information provided to those acting as consultees or legal representatives in a professional, as opposed to a personal, capacity. Incorrect uses of terminology were frequently found, and a small number of studies inaccurately interpreted the law.Conclusions: Despite undergoing ethical review, study documents lacked essential information, incorrectly used terminology, and conflated professionals' clinical and representation roles. Future recommendations include ensuring proxies are provided with adequate and accurate information which complies with the legal frameworks. Further research is needed to explore the information and decision-making needs of those acting as consultees and legal representatives. [ABSTRACT FROM AUTHOR]

Richard Griffith outlines the requirements that must be met when conducting research with participants who lack decision-making capacity. What legal and ethical issues must researchers bear in mind? [ABSTRACT FROM AUTHOR]

Richard Griffith, Senior Lecturer in Health Law at Swansea University, discusses the difficult issue of deprivation of liberty when somebody lacks the capacity to make decisions about their own treatment [ABSTRACT FROM AUTHOR]

The article presents discussion regarding the laws and regulations surrounding the use stored gametes for in vitro fertilization in Great Britain, particularly in cases of posthumous use after the death of the donor. Topics addressed include the ruling of the 2015 R (on the application of IM) v. Human Fertilisation and Embryology Authority High Court case, the need for prior consent, and an overview of existing British law on the issue.

The United Kingdom Supreme Court has ruled that nurses, and other health professionals, can no longer paternalistically decide what information about the risks inherent in treatment should be disclosed to patients when obtaining consent (Montgomery v Lanarkshire Health Board [2015]). Patients must instead be given sufficient information about material risks to enable them to make an informed decision about whether to accept or refuse treatment. This article considers the impact of the Supreme Court ruling on nursing practice. [ABSTRACT FROM AUTHOR]

Intimate examinations, particularly of the genitals and rectum, are often a source of considerable distress and embarrassment to patients (Coldicott et al, 2003). Treatments that involve touching intimate areas may also be a source of unease for nurses. This article will consider the legal and professional obligations on nurses in relation to intimate examinations and treatment. [ABSTRACT FROM AUTHOR]

Best interests is the standard by which the law judges the propriety of care and treatment for adults who lack decision-making capacity. Since the introduction of mental capacity legislation, determining best interests has moved from a paternalistic risk-benefit analysis to a holistic approach where the wishes, views and values of the patient and their relatives must be considered. In this two-part series, the author discusses the concept of best interests and how nurses should approach the determination of best interests to meet the needs of an incapable person. [ABSTRACT FROM AUTHOR]

Following the introduction of the deprivation of liberty safeguards, the courts initially insisted that a deprivation of liberty for the treatment of a mental disorder was authorised under a section of the Mental Health Act 1983 as it had primacy in matters concerning mental disorder (GJ v The Foundation Trust [2009]). The courts later refined that approach to primacy and accepted that, where appropriate, decision makers could use either the Mental Health Act 1983 or the Mental Capacity Act 2005 deprivation of liberty safeguards to authorise a deprivation of liberty for the treatment of a mental disorder. In this third article on the interface between the Mental Health Act 1983 and Mental Capacity Act 2005, the author considers when it would be necessary to detain an adult who lacked capacity under the Mental Health Act 1983 instead of the Mental Capacity Act 2005 deprivation of liberty safeguards. [ABSTRACT FROM AUTHOR]

In the second article on the impact of the Hillsborough football stadium disaster on healthcare law, Richard Griffith discusses the case of Tony Bland, who suffered prolonged hypoxia due to the crushing crowd surge, leaving him in a persistent vegetative state. Some 3 years after the incident, the judicial committee of the House of Lords was asked to rule on whether it would be lawful to withdraw his artificial nutrition and hydration, resulting in death. The opinions of the law lords in Airedale NHS Trust v Bland [1993] continue to inform health law 25 years after the disaster, shaping and developing the use of advance decisions to refuse treatment and setting out when it would be lawful to withdraw futile life-sustaining treatment. [ABSTRACT FROM AUTHOR]