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
What are the different types of proxy?
- continuing power of attorney
- welfare power of attorney
- combined power of attorney
- welfare guardian
- financial guardian
Define a continuing POA.
- covers financial affairs and property
- cannot consent to dental treatment
Define a POA.
- granted when the patient has capacity
- powers remain dormant until required
- registered with office of public guardian
- no expiration date
Define a welfare POA.
- makes welfare decisions including healthcare, dressing and eating
- can consent to dental treatment
Define a combined POA.
- makes both welfare and financial decisions
- can consent to dental treatment
Define a guardianship order.
- court appointed by a Sherriff after the patient has lost capacity
- requires 2 medical reports
- usually expires after 3 years but can be renewed
- can be welfare or financial
Give an example of an AWI who may require a guardianship order.
- a person who is unconscious due to a traumatic accident
- a person with a learning disability who turns 16 and is now an “adult” but requires parents to make decisions for them
Can relatives consent to treatment on another adults behalf?
Only if they have welfare POA or welfare guardianship. If not, they can be involved in the decisions but not consent if the patient does not wish treatment
What is general authority to treat?
- treatment for an AWI who does not have a proxy can be granted if an incapacity certificate is filled out and recorded in the notes
- dentists must go on a short course to be able to complete a certificate of incapacity
- GP can provide if dentist does not have qualification
