Circumstances that affect the decision-making process

Being able to meet a patient’s individual needs for information and support depends, in part, on the time and resources available to you and your colleagues in the organisations where you work. Where there are pressures on your time or resources are limited, you should consider:

1. the role other members of the health and care team might play. See paragraphs 40–41 on Support from other members of the healthcare team.
2. what other sources of information and support are available to the patient, such as patient information leaflets, advocacy services, expert patient programmes, or support groups for people with specific conditions.

If factors outside your control mean that patients aren’t given the time or support they need to understand relevant information (see paragraph 10), and this seriously compromises their ability to make informed decisions, you must consider raising a concern.⁴  You should also consider if it is appropriate to proceed, bearing in mind that you must be satisfied that you have a patient’s consent or other valid authority before providing treatment or care.

In an emergency, decisions may have to be made quickly so there’ll be less time to apply this guidance in detail, but the principles remain the same. You must presume a conscious patient has capacity to make decisions and seek consent before providing treatment or care.

In an emergency, if a patient is unconscious or you otherwise conclude that they lack capacity and it’s not possible to find out their wishes, you can provide treatment that is immediately necessary to save their life or to prevent a serious deterioration of their condition. If there is more than one option, the treatment you provide should be the least restrictive of the patient’s rights and freedoms, including their future choices. See paragraphs 81–84 on Presuming and assessing capacity.

For as long as the patient lacks capacity, you should provide ongoing care following the guidance in paragraphs 87–91. If the patient regains capacity while in your care, you must tell them what has been done and why, as soon as they are sufficiently recovered to understand. And you must discuss with them the options for any ongoing treatment.