1. Introduction
    1. What ?
      1. Seeking approval from the patient
        1. Consent can only be obtained by the doctors and nurses who are involved directly in the patient's care.
        2. The patient is then being informed about the different options that are available.
        3. Providing the patient with enough details and sufficient time to make a decision.
    2. Why ?
      1. Autonomy
        1. Basic human right
        2. The process of obtaining consent for clinical studies should uphold the patient's decision-making ability and follow the specific rules of the hospital.
    3. When ?
      1. Every time you touch a patient !
      2. Types of consent
        1. Implied
        2. Express
          1. Oral / Verbally
          2. Written
          3. Better for documentation
          4. A must for
          5. Treatment
          6. Dissemination of patient's information.
          7. Discussion of HIPPA laws
          8. Specific procedures
          9. Surgery
          10. Blood transfusion
          11. Anesthesia
          12. Valid for 30days
  2. Components of informed consent
    1. Competency / Legal capcity
      1. Ability to comprehend the nature, purpose, and consequences of the offered treatments.
      2. Consent is given freely and voluntarily
      3. Must be mentally competent to decide whether or not they want to go ahead with the procedure or intervention.
    2. Autonomy
      1. The right to refuse, regardless of the reason
        1. Eg. Religion, skepticism, other...
    3. Understanding
      1. Information to be given
        1. Introduction
          1. Introducing yourself
          2. Diagnosis
          3. Name of the advised treatment
        2. Explaining
          1. Nature and purpose of the treatment
          2. Expected benefits, common side effects and risks of treatment
        3. Alternatives
          1. Other options for investigation/ treatment
          2. May include the risks and benefits too
        4. Consequences of refusing the treatment
          1. The right to refuse treatment
          2. Consequences of that tight (serious injury, death )
          3. May have to sign AAMA /AOR form (Against medical advice / At own risk)
  3. Exception
    1. No consent
      1. Doctrine of Emergency
        1. Life threatening situation
        2. Possible serious health impairment
        3. Impossible to obtain the patient's consent :
          1. If there's no time to obtain consent
          2. If the patient is unable to communicate
          3. If there's no surrogate decision maker available
        4. It's presumed that treatment is wanted
        5. Unless there are advance care directive
          1. A written record that records the values, life goals and preferred outcomes or directions about care and treatments.
          2. Eg. DNR (Do not resuscitate), not for CPR, intubation.
    2. Consent from others
      1. Minors = Young people under 18years old
        1. The guardian decides
        2. Must act in the best interest of the minor
        3. Minor's wishes have to be considered
        4. Court may take over the guardianship
      2. Incompetence
        1. Lack of capacity to make treatment decisions
          1. Eg: People with intellectual disabilities/ Those affected by certain forms of mental illness.
        2. Inability to comprehend the risks and benefits
        3. Communication issues are NOT under this criteria
        4. Guardian requires (substituted consent )
          1. Advance Care Directives can also formally appoint a substitute decision-maker
  4. Application to case
  5. Legislation applying to guardianship decision making framework : Guardianship and Administration Act 1990 (WA)
  6. Case law :