4 - Adults with incapacity Flashcards
What is capacity?
- adults over 16
- can consent to medical and dental treatment
- can make legally binding decisions
What is the AWI act?
- framework to safeguard welfare and finances of those who lack capacity due to mental illness, learning disability or are unable to communicate
- supports AWI to be involved in decision that impact their life
Define incapacity legally.
Inability of an adult to enter into a legally binding contract (adult = 16 years or older)
How do you asses capacity?
- presumed
- is decision or action specific, may have capacity for simple concepts but not complex
- residual capacity should be considered
- ensure information given to patient is simple and understandable
- assessment should be recorded including retention
Who may not have capacity?
- mental disorders including dementia, mental illness, ABI, autism
- physical disorder that impairs communication even when assisted ie locked in syndrome, unconscious post accident
Define incapacity in respect to dental consent.
Being incapable of:
A - acting
M - making a decision
C - communicating decision
U - understanding decision
R - retaining memory of decision
How does communication impact capacity?
- a person is not incapable of making a decision if they have a lack of communication that can be improved by other aids ie hearing aid, BSL, writing on a board
- ensure a quiet and well lit environment with plenty of time
- everything should be tried to communicate with a patient before rending them incapable due to communication
How does understanding impact capacity?
- if a person cannot understand why the treatment is necessary then they may be deemed incapable
- if they do not understand the consequences of not getting treatment
What are the principles of the AWI act?
- benefit
- minimum necessary intervention
- take into account the wishes of the adult
- consultation with relevant others
- encourage adult to exercise residual capacity
Describe the principle of benefit in the AWI act.
- any treatment must benefit the patient
- without treatment the benefit would not be possible
- any intervention must improve or enhance their life
Describe the principle of minimum necessary intervention in the AWI act.
- action or decision should be minimum necessary to achieve purpose
- restricts freedom as little as possible
- seek to avoid invasive treatments when simpler options are available
- does not refer to simplest solution if better option is available
- absolute minimum intervention could be considered discrimination by not offering all treatment
Describe the principle of taking into account the adults wishes in the AWI act.
- ask the patient
- ask relatives or close friends of the patients previous wishes
- patient passport or previous notes may advise
- a heavily restored mouth may show previous investment in dental health
Describe the principle of consultation with relevant others in the AWI act.
- if you do not know the patient well you may not know their lifestyle or previous wishes
- family, friends, guardian, attorney are examples of relevant others
Who are the relevant others you should consult when making a decision for an AWI?
- nearest relative and primary carer
- guardian, POA
- anyone who the sheriff decides
- anyone who has an interest in the welfare of the adult
What is residual capacity?
- identify if the patient can make any decisions for themselves
- encourage the adult to exercise skills that they still possess
