10. CAPACITY Flashcards
- What can lead to us lacking Capacity?
- an impairment or disturbance in the functioning of the
brain or mind
- What is Capacity a part of?
- Consent
- What are the 3 Criteria of informed and valid consent?
- Competence
- Voluntariness
- Sufficient Information
- Is Capacity a legal or a medical concept?
- Legal
- What is Capacity?
- it is the ability to give permission to have treatment
- it is the ability to withhold permission and refuse
treatment
- What do all the choices and decisions made in a clinical context flow from?
- they flow from the assessment of Capacity
- What are the starting point assumptions made about Capacity?
- 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
- What are 3 examples of patients who are deemed not to have capacity about their situation?
- Patients with Intellectual Disabilities
- Patients with Dementia
- Patients with Acute Alcohol Intoxication
NB:
- these kinds of patients sill have the ability to give
consent
- When is the only time a patient is assumed to lack the capacity to consent?
- when the patient is unconcious
- According to the WMA Declaration of Patient Rights, what is said about the protocols that must be followed when you have an unconscious patient?
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
- Where was the test, that is currently used to measure Capacity in medicine, created?
- it was created as a result of the case of Mr C in 1994
- he was an adult that was refusing treatment
- What happened with the case of Mr C in 1994?
- 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
- What does the Mental Capacity Act of 2005 state?
- EVERY ADULT HAS THE RIGHT TO MAKE THEIR OWN
DECISIONS- they should be assumed to have the capacity unless
proven otherwise
- they should be assumed to have the capacity unless
- EVERYONE SHOULD BE ENCOURAGED AND ENABLED
TO MAKE DECISIONS- or to participate in the decision making process
- PEOPLE HAVE THE RIGHT
- to make eccentric or unwise decisions
- 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
- According to the Mental Capacity Act of 2005, what should a patient with the capacity be able to do?
- UNDERSTAND
- the information that is relevant to the decision
- RETAIN
- the information
- USE OR WEIGHT THE INFORMATION
- as part of the decision-making process
- COMMUNICATE THEIR DECISION
- this can be done orally
- in sign language
- in written form
- What factors can temporarily affect an individual’s capacity to make particular decisions?
- pain
- fear
- confusion
- the effects of medication
- How can the assessments of Capacity be done?
- they must be time specific
- they must be decision specific
- According to the BMA Law Society Guidelines of 2004, what should a patient be able to do in the Medical sense?
- 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
- UNDERSTAND THE TREATMENT’S
- principle benefits
- principle risks
- principle alternatives
- UNDERSTAND, IN BROAD TERMS
- the consequences of not receiving the proposed
treatment
- the consequences of not receiving the proposed
- RETAIN THE INFORMATION FOR LONG ENOUGH
- to make an effective decision
- MAKE A FREE CHOICE
- Who are patients that are special considerations to the measure of Capacity?
- patients with mental illnesses
- young patients
- elderly patients
- What can be said about capacity, consent and the age of a child?
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
- Who usually makes the medical decisions on behalf of children?
- their parents
- their legally appointed guardian
- What are Proxy decision makers?
- 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
- What are Advance Decisions?
- 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
- If Proxy Decision Makers and Advance Decisions are not available, what should the Medical Practitioner do?
- 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
- What information does a doctor need to explore what is best for the patient in terms of the patient’s perspective?
- 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
- What default assumption does the doctor hold about adult patients?
- that they have the capacity to make decisions
- What should a doctor do when it comes to measuring a patient’s capacity?
- 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
- What process must the patient be involved in?
- they must be involved in the decision making process
to the fullest extent - this extent is determined by their capacity
- What do we do in this case if the patient is competent?
- we consider whether there is a risk of serious
psychological and physical harm
- What do we do in this case if the patient is incapacitated?
- we decide who the appropriate surrogate is to make
decisions for the incapacitated patient
- What do we do in this case in general?
- 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
- Does this summary make sense?
- yes
- Answer these questions.
- this can be done verbally or on paper