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MED 105- MEDICAL ETHICS > 10. CAPACITY > Flashcards

10. CAPACITY Flashcards

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USMLE® Step 1 flashcards
1
Q
  1. What can lead to us lacking Capacity?
A
  • an impairment or disturbance in the functioning of the
    brain or mind
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2
Q
  1. What is Capacity a part of?
A
  • Consent
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3
Q
  1. What are the 3 Criteria of informed and valid consent?
A
  1. Competence
  2. Voluntariness
  3. Sufficient Information
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4
Q
  1. Is Capacity a legal or a medical concept?
A
  • Legal
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5
Q
  1. What is Capacity?
A
  • it is the ability to give permission to have treatment
  • it is the ability to withhold permission and refuse
    treatment
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6
Q
  1. What do all the choices and decisions made in a clinical context flow from?
A
  • they flow from the assessment of Capacity
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7
Q
  1. What are the starting point assumptions made about Capacity?
A
  • all adults are presumed capacious
  • assessments are only to be carried out where there is
    legitimate doubt about a patient’s capacity
  • assessments should never be carried out because of
    disagreement
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8
Q
  1. What are 3 examples of patients who are deemed not to have capacity about their situation?
A
  1. Patients with Intellectual Disabilities
  2. Patients with Dementia
  3. Patients with Acute Alcohol Intoxication

NB:
- these kinds of patients sill have the ability to give
consent

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9
Q
  1. When is the only time a patient is assumed to lack the capacity to consent?
A
  • when the patient is unconcious
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10
Q
  1. According to the WMA Declaration of Patient Rights, what is said about the protocols that must be followed when you have an unconscious patient?
A

IF THE PATIENT IS UNCONSCIOUS OR UNABLE TO EXPRESS THEIR WILL:
- informed consent must be obtained whenever
possible
- this consent must be obtained from a legally entitled
representative

IF THE LEGALLY ENTITLED REPRESENTATIVE IS UNAVAILABLE:
- consent of the patient may be presumed
- if a medical intervention is urgently needed
- unless the patient has previously firmly expressed that
they will refuse to give consent

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11
Q
  1. Where was the test, that is currently used to measure Capacity in medicine, created?
A
  • it was created as a result of the case of Mr C in 1994
  • he was an adult that was refusing treatment
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12
Q
  1. What happened with the case of Mr C in 1994?
A
  • the patient was in a psychiatric secure hospital
  • he had Chronic Paranoid Schizophrenia
  • he had grandiose delusions of being a world famous
    doctor
  • he developed a gangrenous leg
  • an amputation was recommended
  • Mr C refused the amputation
  • this led the Medical World to question whether a man
    with delusions and paranoia has the capacity to make
    decisions about his physical health
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13
Q
  1. What does the Mental Capacity Act of 2005 state?
A
  1. EVERY ADULT HAS THE RIGHT TO MAKE THEIR OWN
    DECISIONS
    • they should be assumed to have the capacity unless
      proven otherwise
  2. EVERYONE SHOULD BE ENCOURAGED AND ENABLED
    TO MAKE DECISIONS
    • or to participate in the decision making process
  3. PEOPLE HAVE THE RIGHT
    • to make eccentric or unwise decisions
  4. PROXY DECISIONS
    • should be made for the patient’s best interest
    • they should be the least restrictive of the patient’s
      basic rights and freedoms
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14
Q
  1. According to the Mental Capacity Act of 2005, what should a patient with the capacity be able to do?
A
  1. UNDERSTAND
    • the information that is relevant to the decision
  2. RETAIN
    • the information
  3. USE OR WEIGHT THE INFORMATION
    • as part of the decision-making process
  4. COMMUNICATE THEIR DECISION
    • this can be done orally
    • in sign language
    • in written form
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15
Q
  1. What factors can temporarily affect an individual’s capacity to make particular decisions?
A
  • pain
  • fear
  • confusion
  • the effects of medication
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16
Q
  1. How can the assessments of Capacity be done?
A
  • they must be time specific
  • they must be decision specific
17
Q
  1. According to the BMA Law Society Guidelines of 2004, what should a patient be able to do in the Medical sense?
A
  1. UNDERSTAND IN SIMPLE LANGUAGE
    • what the medical treatment is
    • understand the nature of the treatment
    • understand the purpose as to why the treatment is
      being proposed
  2. UNDERSTAND THE TREATMENT’S
    • principle benefits
    • principle risks
    • principle alternatives
  3. UNDERSTAND, IN BROAD TERMS
    • the consequences of not receiving the proposed
      treatment
  4. RETAIN THE INFORMATION FOR LONG ENOUGH
    • to make an effective decision
  5. MAKE A FREE CHOICE
18
Q
  1. Who are patients that are special considerations to the measure of Capacity?
A
  • patients with mental illnesses
  • young patients
  • elderly patients
19
Q
  1. What can be said about capacity, consent and the age of a child?
A

IN MANY COUNTRIES:
- people need to be 18 to consent to treatment

IN SOME COUNTRIES:
- children can consent at an earlier age
- the consent age in the UK is 16
- children cannot refuse life-threatening treatment until
they are 18

20
Q
  1. Who usually makes the medical decisions on behalf of children?
A
  • their parents
  • their legally appointed guardian
21
Q
  1. What are Proxy decision makers?
A
  • these are the patient’s legal representatives
  • people can appoint someone to act as a proxy decision
    maker for them in case they lose their capacity
22
Q
  1. What are Advance Decisions?
A
  • these are known as Living Wills
  • they are the statements made by patients at the time
    that they have their capacity
  • these statements are about how they want to be
    treated in the future if they were to lose their capacity
23
Q
  1. If Proxy Decision Makers and Advance Decisions are not available, what should the Medical Practitioner do?
A
  • they should determine the best interests of the patient
  • this involves taking into consideration the patient’s
    diagnosis
  • the patient’s prognosis is also taken into account
  • the patient’s medical beliefs are considered
24
Q
  1. What information does a doctor need to explore what is best for the patient in terms of the patient’s perspective?
A
  • the patient’s past and present wishes
  • the patient’s feelings
  • the patient’s previously written statements
  • information received from those who are significant in
    the patient’s life
  • information received from those who want to
    determine the patient’s best interests

OTHER FACTORS:
- beliefs
- values
- culture
- religion
- this would all influence the treatment decision

25
Q
  1. What default assumption does the doctor hold about adult patients?
A
  • that they have the capacity to make decisions
26
Q
  1. What should a doctor do when it comes to measuring a patient’s capacity?
A
  • the doctor should take into account any previous notes
    on the patient’s capacity
  • the doctor should run a fresh assessment of the
    patient’s capacity with respect to the specific
    consultation and decision to be made
27
Q
  1. What process must the patient be involved in?
A
  • they must be involved in the decision making process
    to the fullest extent
  • this extent is determined by their capacity
28
Q
  1. What do we do in this case if the patient is competent?
A
  • we consider whether there is a risk of serious
    psychological and physical harm
29
Q
  1. What do we do in this case if the patient is incapacitated?
A
  • we decide who the appropriate surrogate is to make
    decisions for the incapacitated patient
30
Q
  1. What do we do in this case in general?
A
  • we explore how much the patient wants to know
  • we consider whether the patient’s capacity can be
    enhanced
  • we consider how to minimise the risk of harm
31
Q
  1. Does this summary make sense?
A
  • yes
32
Q
  1. Answer these questions.
A
  • this can be done verbally or on paper

MED 105- MEDICAL ETHICS (36 decks)

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