Psych CASC / OSCE · Intellectual disability — capacity and supported decision-making
Supported decision-making for elective surgery consent — CASC communication station
MRCPsych/FRANZCP-style CASC: accessible disclosure, teach-back, four abilities, supported decision-making, response to carer seeking automatic substitute authority, and clear next steps for elective care.
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Station brief
Format. Communication station, approximately 7–10 minutes active time after reading. You are the psychiatry registrar asked to help with consent for elective day-case hernia repair. [1]
Candidate instructions. Assess decision-making capacity for elective hernia repair. Use plain language and teach-back. Offer supports. Involve the support worker appropriately without allowing them to answer every question. If capacity appears present, respect consent or refusal. If capacity appears impaired after supports, explain next steps (delay and enhance; lawful substitute pathway under local law — no invented section numbers). Avoid humiliation and coercion. [1][2]
References4ShowHide
- [1]Appelbaum PS Clinical practice. Assessment of patients' competence to consent to treatment N Engl J Med, 2007.PMID 17978292
- [2]Sullivan WF, Heng J Supporting adults with intellectual and developmental disabilities to participate in health care decision making Can Fam Physician, 2018.PMID 29650742
- [3]Devi N Supported decision-making and personal autonomy for persons with intellectual disabilities: article 12 of the UN convention on the rights of persons with disabilities J Law Med Ethics, 2013.PMID 24446938
- [4]Sessums LL, Zembrzuska H, Jackson JL Does this patient have medical decision-making capacity? JAMA, 2011.PMID 21791691