Consent and People with Learning Disabilities
The legal framework surrounding the issue of consent and people with learning disabilities is now embedded firmly within the Mental Capacity Act 2005 (see separate resources). Prior to this cases involving consent were dictated by what had come before, i.e. common, or case law. For a breakdown of key cases in the UK please follow the link given at the bottom of this page.
The most important point to remember when considering consent and working with people who have a learning disability is that consent should be viewed as a “process” and not a one-off event. Each time that consent is required then the person’s capacity and understanding should be reviewed and applied to each individual situation (consider the difference between consenting to having a wash and consenting to a major operation). Remember, nobody else can give consent on behalf of another adult.
In order to ensure that the person giving consent is giving “informed” consent then a number of principles need to be applied to the process:
For a person’s consent to be valid, the person must be:
• capable of taking that particular decision (‘competent’)
• acting voluntarily (not under pressure or duress from anyone)
• provided with enough information to enable them to make the decision
Therefore, it is extremely important that as practitioners, we explore ways of gaining informed consent, and this is particularly important when working with people who have learning disabilities. These people may not be able to verbally communicate their wishes or level of understanding and may need much more time to process the information given. TIME and SUPPORT are therefore key in this process. There are many different ways in which a person can give consent. Some may be verbal may others may involve gestures and non-verbal cues. Remember, a consent form, while good practice, is only a record and not proof that genuine consent has been given. In reference to the second point outlined above, a practitioner should not confuse capacity with their own assessment of what they think is “reasonable”.
Consider the following examples from practice.
- A thirty year old man with moderate learning disabilities living in a residential home with three other people. He has refused to wash or have a bath for over two months and the staff and residents have begun to complain to his consultant psychiatrist and community nurse. The psychiatrist believes that the best thing to do is to section him under the Mental Health Act 1983 and essentially “force” him to wash.
What do you think are the key issues here?
If you were the community nurse, what might you need to consider?
- A sixteen year old girl with Autistic Spectrum Disorder and moderate to severe learning disabilities was prescribed the contraceptive pill due to her extreme fear of blood during menstruation and the distress that this subsequently caused. As she has begun to put on weight since being prescribed the pill she now needs to have her blood pressure taken regularly but is very frightened of this process.
What do you think are the key issues here?
How do you think as a nurse you can support the girl and her family with this process?
(link to gillick competency and fraser guidelines re. young people