ML02P ADULT SURGICAL PATIENTS: THE QUESTION OF COMPETENCY TO CONSENT

Abstract

Surgeons are well aware of the legal and ethical implications of failing to provide informed consent. However, consenting patients for surgical procedures becomes more challenging when there is a question regarding the patient's competency, especially when the patient is refusing life saving treatment.In Australia, the Common Law presumes every adult is competent to consent to medical treatment until proven otherwise. There are three capacities one requires for competency in decision making and hence the ability to consent to treatment. Firstly a person requires the capacity for understanding and communication. Secondly, they need to be able to reason and deliberate and thirdly a person requires a set of values or the conception of good.Guardianship legislation exists in all states involving consent to medical treatment of adults who lack capacity to consent on their own behalf. This legislation exists to protect the autonomy of the patient and promote their best interests. It provides for a substitute decision maker to act on behalf of the incompetent patient.I will refer to a number of factors which may interfere with a patient's competency to give consent or refuse treatment, some of which are reversible. I will discuss the definition of competency of adults to consent or refuse treatment with reference to current laws in Australia, the issue of autonomy and the duty of care a surgeon must provide their patient in regards to informed consent in the context of the incompetent patient.