Adults with Incapacity Flashcards

1
Q

What is the Adults with Incapacity (Scotland) Act 2000?

A

framework for safeguarding the welfare and managing the finances of adults who lack capacity due to mental illness, learning disability or a related condition, or an inability to communicate

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2
Q

What is the aim of the Adults with Incapacity (Scotland) Act 2000?

A

protect people who lack capacity to make particular decisions, but also support their involvement in making decisions about their own lives are far as they are able to do so

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3
Q

What part of the Adults with Incapacity (Scotland) Act 2000 covers medical and dental treatment?

A
  • Part 5
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4
Q

What is incapacity?

A
  • inability of an adult to enter into legally binding contracts
    • person over 16 years
    • condition to the extent they cannot understand what a decision involves or make a true choice
    • decision has no legal effect
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5
Q

How is capacity assessed?

A
  • presume capacity for all patients
  • capacity is decision or action specific
    • not all or nothing
  • capacity can fluctuate
    • may differ throughout the day
    • unconscious patient
    • commonly seen with dementia patients
  • consider residual capacity
  • record capacity assessment
    • gather evidence from range of sources
    • listen carefully to patient
  • keep language appropriate
    • simple
    • no jargon
  • chunk and check
    • break up information into sections
    • ask patient to explain what has been discussed
  • check retention
    • ask the patient about subsequent appointments
    • always leave 24 hours before treatment to allow time to consider options
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6
Q

What does not render someone to have impaired capacity?

A
  • in care
  • mental health condition
  • difficulties with speech or writing
  • addiction issues
  • brain injury
  • physical disability
  • in prison
  • neurological condition
  • not behaving rationally
  • disagree with you
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7
Q

How is incapacity determined

A
  • being incapable of:
    • Acting
    • Making a decision
    • Communicating their decision
    • Understanding their decision
    • Retaining memory of their decision
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8
Q

What aids are available for communication?

A
  • sign language
  • text to speech
  • visual aids
  • patient information leaflets
  • loop systems
  • spelling boards
  • iPads
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9
Q

How can individuals demonstrate capacity?

A
  • understanding in simple language what the treatment is, its purpose and nature, and why it is being proposed
  • understand its principle benefits, risks and alternatives
  • understand in broad terms the consequences of not receiving the proposed treatment
  • retain information long enough to use it and weigh it in the balance in order to arrive at a decision
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10
Q

What are the 5 key principles that underpin the Adults with Incapacity Act?

A
  • benefit the adult
    • treatment must benefit the patient
    • without treatment benefit would not be possible
    • intervention must improve or enhance life
  • minimum necessary intervention
    • consider longevity required
    • many not be the minimum/simplest treatment possible
    • restricts freedom as little as possible
  • take into account the wishes of the adult
    • what did the patient previously want (also current wants)
    • ask patent
    • look for a patient passport or care home notes
    • heavily restored dentition shows previous treatment
    • aesthetic treatment shows investment in mouth
    • missing teeth, potentially reluctant to attend dentist
  • consult relevant others
    • family (primary carer)
    • guardian
    • legal professionals
    • what the patient would have wanted
  • encourage the adult to exercise residual capacity
    • allow patient to make decisions that they are still able to
    • must consider reversibility of the condition
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11
Q

What is proxy?

A
  • a suitable adult substitute decision maker for someone without capacity
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12
Q

What are the three types of power of attorney and which can consent for dental treatment?

A
  1. continuing power of attorney
    • cannot consent for dental treatment
  2. welfare power of attorney
    • can consent for dental treatment
  3. combined power of attorney
    • can consent for dental treatment
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13
Q

What are the two types of guardianship orders and which can consent for dental treatment?

A
  1. welfare guardian
    • can consent for dental treatment
  2. financial guardian
    • cannot consent for dental treatment
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14
Q

What is power of attorney?

A
  • granted while a patient has capacity for someone to act on their behalf should the need arise
    • dormant until demonstrated needed
    • no expiry date (indefinite once capacity lost)
    • can be more than one person
    • often family member or trusted friend
  • organised through lawyer
    • does not need to go to court
    • registered with the Office of the Public Guardian (OPG)
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15
Q

What is continuing power of attorney?

A
  • financial power of attorney
    • only covers financial affairs and property
    • cannot consent to dental treatment
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16
Q

What is welfare power of attorney?

A
  • only comes into effect if adult loses capacity
    • must take into account adults wishes
    • welfare decisions including healthcare, dressing, eating
    • can consent to dental treatment
17
Q

What is combined power of attorney?

A
  • welfare and financial decisions
    • can consent to dental treatment
17
Q

What is combined power of attorney?

A
  • welfare and financial decisions
    • can consent to dental treatment
18
Q

What are guardianship orders?

A
  • court appointed person to make decisions on behalf of an adult with incapacity
    • appointed by Sheriff after capacity lost
    • power of attorney not in place
  • requires 2 medical reports
  • continuous management of welfare and financial matters
    • powers to deal with property, finance, marital affairs etc.
  • appointed for 3 years
    • can be extended appointment for 10 years
    • cannot be indefinite
  • does not automatically apply after 16 years
    • guardianship must be granted through courts
19
Q

Who can consent for dental treatment?

A
  • patients with capacity
  • welfare powers of attorney
  • welfare guardians
  • medical and dental practitioners
    • under section 47 of Adults with Incapacity Act
    • general authority to treat
    • required extra training
20
Q

What is general authority to treat?

A

medical and dental professionals attend additional training to allow them to provide a valid certificate of incapacity to be issued for the treatment given and carry out treatment provided the principles of the act are observed

21
Q

What does common law state about capacity?

A

common law allows medical treatment to be given in an emergency to patients who cannot consent
- reasonable in an emergency to take reasonable action
- safeguard a person unable to consent
- without treatment there would be significant harm

22
Q

What are certificates of incapacity?

A
  • certificate to classify a patient as not having capacity
    • only valid for area of practice in which issued
  • certificate must be completed even where proxy has been appointed