Vaccine

[Old Greg]

It seems to be a requirement, if you have failed one. So people are asking why.

Mental capacity and consent is an interesting topic. In general, you need to be able to consent to a treatment (different and quite complex rules apply for children). If you lack capacity, then an overall benefit test applies. My guess is that anything vaccine related is following this approach.

https://www.gmc-uk.org/-/media/docum...90443F0E0651DA

Making a decision when the patient lacks capacityverall benefit
87 We use the term ‘overall benefit’ to describe the ethical basis on which
decisions are made about treatment and care for adult patients who lack
capacity to decide for themselves. This involves weighing up the risks of
harm and potential benefits for the individual patient of each of the available
options, including the option of taking no action. The concept of overall benefit
is consistent with the legal requirements to consider whether treatment
‘benefits’ a patient (Scotland), or is in the patient’s ‘best interests’ (England,
Wales and Northern Ireland).
88 If you are the treating doctor, before concluding that it is your responsibility
to decide which option(s) would be of overall benefit to a patient who lacks
capacity, you should take reasonable steps to find out:
a whether there’s evidence of the patient’s previously expressed values
and preferences that may be legally binding, such as an advance statement
or decision
b whether someone else has the legal authority to make the decision on the
patient’s behalf or has been appointed to represent them.
36 General Medical Council gmc-uk.org General Medical Council gmc-uk.org 37
Decision making and consent Circumstances that affect the decision-making process
89 If there is no evidence of a legally binding advance refusal of treatment,
and no one has legal authority to make this decision for them, then you are
responsible for deciding what would be of overall benefit to your patient.
In doing this you must:
a consult with those close to the patient and other members of the
healthcare team, take account of their views about what the patient would
want, and aim to reach agreement with them
b consider which option aligns most closely with the patient’s needs,
preferences, values and priorities
c consider which option would be the least restrictive of the patient’s
future options.
90 If a proposed option for treatment or care will restrict a patient’s right to
personal freedom, you must consider whether you need legal authorisation to
proceed with it in the circumstances.
91 You should allow enough time, if possible, for discussions with those who have
an interest in the patient’s welfare, and you should aim to reach agreement
about how to proceed.
36 General Medical Council gmc-uk.org General Medical Council gmc-uk.org 37
Decision making and consent Circumstances that affect the decision-making process
Resolving disagreements
92 Sometimes members of the healthcare team disagree about what would be
of overall benefit to the patient, or those close to the patient disagree with
you and the healthcare team. It is preferable, and usually possible, to resolve
disagreements about a patient’s treatment and care through local processes.
For example, by:
a involving an independent advocate or local mediation service
b consulting a more experienced colleague and/or an independent expert
c holding a case conference or seeking advice from a clinical ethics
committee.
93 If, having taken these steps, there is still disagreement about a significant
decision, you must follow any formal steps to resolve the disagreement that
are required by law or set out in the relevant code of practice. You must make
sure you are aware of the different people you must consult, their different
decision-making roles and the weight you must attach to their views. You
should consider seeking legal advice and may need to apply to an appropriate
court or statutory body for review or for an independent ruling. Your patient,
those close to them and anyone appointed to act for them should be informed
as early as possible of any decision to start legal proceedings, so they have the
opportunity to participate or be represented.

[Old Greg]

They want the GPs to go around and redo the mental capacity act form. For like every dementia patent. But they are saying "we are kind of busy" and the obvious question they ask is "so you dont think it is safe"

Safety and risk is one element of this. Another is that giving a vaccine would constitute assault in the absence of consent, unless the overall benefit test is met. Worth noting that there are some differences in law between England & Wales, Scotland, and NI. I can't remember enough about them to say whether they are relevant here.

[Old Greg]

Worth a look at: Consent to coronavirus (COVID-19) vaccination | Alzheimer's Society

Mental Capacity Act 2005 applies to England and Wales.

What if the person with dementia no longer has mental capacity?The Mental Capacity Act 2005 (MCA) says that we must always support decision-making. As well as giving people information in a way they can understand, this could mean communicating with them at their most alert time of day. The MCA also says that we must assume capacity unless we have reasonable doubt. If there is reason to doubt capacity, this needs to be assessed by an appropriate person, often their GP.


If the person does not have mental capacity to make the decision themselves then a ‘best interests’ decision about vaccination will need to be made on their behalf, although they should still be involved as much as they can. If the person with dementia has appointed an attorney for health and welfare, the attorney should discuss things with professionals but it is ultimately the attorney’s decision.


Otherwise, the decision will be made by health professionals in consultation with those closest to the person and those who know them best. The best interests decision-making must focus on the individual person and include looking at the risks and benefits of them having or not having the vaccine. If possible the decision should be made in good time before any possible vaccination and recorded in the person’s care record.


Under the MCA, the best interests decision must also take into account the person’s past and present wishes and feelings. For example, have they held strong views against vaccines? Have they always been public-spirited, thinking about the well-being of others first?


There may be indirect benefits to the person from vaccination, such as the possible relaxation of rules about visitor contact. These might also be relevant when looking at the person’s best interests.


The care home may have an interest in all its residents being vaccinated but it must not exert undue influence or seek to over-ride a best interests decision.


Where similar issues have arisen over consent to coronavirus testing, legal opinion in most cases has so far been that it is in the person’s best interests to have a test. Government guidance on testing for someone without mental capacity aligns with this. It seems likely that the same will apply to vaccination, but an individualised approach is still needed.

[minestrone]

My only knowledge of mental capacity is through financial regulation.

But I was told, the form does them for 3 years, and they want a new one done before the vaccine. I'm only the messenger here. But that was questioned by people I know.

[Old Greg]

My only knowledge of mental capacity is through financial regulation.

But I was told, the form does them for 3 years, and they want a new one done before the vaccine. I'm only the messenger here. But that was questioned by people I know.

A new one done for which particular patient group? Everyone? Everyone over a certain age?

[minestrone]

A new one done for which particular patient group? Everyone? Everyone over a certain age?

I was very sure of my statemen August,

I have a great respect for my wonderful wife who has medical degree. you have hooked up with a very simple person.

[Old Greg]

I was very sure of my statemen August,

I have a great respect for my wonderful wife who has medical degree. you have hooked up with a very simple person.

I will pass your illucid comment onto Mrs OG, who, I am sure, will cry herself to sleep into her Congnitive Neuroscience PhD cert.

[minestrone]

I will pass your illucid comment onto Mrs OG, who, I am sure, will cry herself to sleep into her Congnitive Neuroscience PhD cert.

Shes not a doctor.

[Old Greg]

Shes not a doctor.

You were saying before that she is a very simple person, but it turns out she has a PhD in cognitive neuroscience.

This thread illustrates one of your flaws, minny. There was quite an interesting conversation to be had around capacity, consent and vaccination, but you just had to flip out into an illucid logical non sequitur.

Never mind.

[minestrone]

You were saying before that she is a very simple person, but it turns out she has a PhD in cognitive neuroscience.

This thread illustrates one of your flaws, minny. There was quite an interesting conversation to be had around capacity, consent and vaccination, but you just had to flip out into an illucid logical non sequitur.

Never mind.

Your wife isn't as intelligent as mine.