adults with incapacity Flashcards
what do we presume about somebody’s capacity before we know whether they have capacity or not
Also presume somebody has capacity until we work out that they don’t have capacity
- Everybody should be treated equally
- Everyone should be assumed to have capacity unless proven otherwise
- Responsibility upon healthcare practitioners to assess capacity
- For those who lack capacity, care must be facilitated to ensure equality in the provision of care ~ Should not be treated differently
what legislation protects adults with incapacity
Adults with Incapacity (Scotland) Act 2000
Code of Practice (3rd Edition)
For practitioners authorised to carry out medical treatment or research under part 5 of the act
Effective from 10 May 2010
Laid before the Scottish Parliament by the Scottish Ministers pursuant to section 13(3) of the Adults with Incapacity (Scotland) Act 2000
April 2010
what is the adults with incapacity act
• 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
• The Act aims to protect people who lack capacity to make particular decisions, but also to support their involvement in making decisions about their own lives as far as they are able to do so
○ Sometimes people are able to make simple decisions but not more complex ones
define capacity
The ability or power to:
• Receive impressions
• Receive knowledge
• Do or understand something
why is capacity important
• Decision making - Capacity is key to autonomy
○ Everyone has the right to say what happens to their body
○ Everyone has the right to say what they don’t want to happen to their body
- In terms of healthcare, competent adults have the right to refuse treatment
- Failure to treat adults who do not have capacity may constitute negligence
who has capacity
Everyone has capacity until proven otherwise
what is incapacity
- Legal definition - defined in AWI Act
- Inability to enter into legally binding contracts
- Refers to adults
- “adult” means a person who has attained the age of 16 years or older
for the purposes of the act, what does incapable mean
For purposes of the act, incapable means incapable of:
• Acting
• Making decisions
• Communicating decisions
• Understanding decisions [Being able to talk back to you and tell you what they think you meant]
• Retaining the memory of decisions
how does communication affect capacity
“a person CANNOT be considered to be lacking capacity because of a lack or deficiency in communication - if that lack or deficiency can be made good by human or mechanical aid”
“there is an onus on involved personnel to ensure that the individual with a communication difficulty is supported to maximise their communication”
how can you communicate to ensure capacity with a patient if they cannot speak to communicate their decision
If a person cannot speak in order to communicate their decision:
• Can they write it?
○ If yes, give them a pen and paper
If they cannot write or speak in order to communicate their decision:
• Can they sign or use gestures?
○ If yes, facilitate this for them
how can you ensure adequate communication for all patients
• Find out how the person communicates - ask!!
○ Even if the patient cannot answer you, someone with them (family member / carer) might be able to tell you
- Check if they are wearing or have with them their normal aids
- Ensure a quiet, well lit environment
• Allow adequate time
○ Does take longer to communicate
• Use technology
○ Loop systems
○ Spelling boards
○ iPad ~ even a phone
• Consider communication adjuncts
how can you assess capacity
- Decision or action specific
- NOT ‘all or nothing’
• Consider ‘residual capacity’
○ Can understand some things, not all things maybe
- Capacity may fluctuate
- Patients may be able to make some decisions for themselves, but may lack capacity to make other decisions
- So for everything you do you have to assess the capacity of the patient at that time to understand
when can you not automatically assume the adult has impaired capacity
- They are in care
- They have a mental health condition
- They have difficulties with speech or writing
- They have addiction issues
- They have a brain injury
- They have a physical disability
- They are in prison
- They have a neurological condition
- They are not behaving rationally
- They disagree with you
what should individuals be able to do to demonstrate capacity
- Understand 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 what will be the consequences of not receiving the proposed treatment
• Retain the information long enough to use it and weigh it in the balance in order to arrive at a decision
○ (Scotland - “retain the memory of the decision”)
what should assessmnet of capacity seek to determine about the patient
Assessment should seek to determine if the patient:
- Is capable of making and communicating a choice
- Understands the nature of what is being asked and why
• Has memory abilities to allow them to retain information you have give
○ Be able to feed it back to you
- Is aware of risks and benefits involved
- Is aware of personal relevance to them
- Is aware of the right to (and how to) refuse treatment
• Has ever previously expressed a view or opinion on the subject
○ Can do this with family members etc if you cannot get the information from someone else
• Is not under undue influence from you or anyone else
○ Family member / carer does not have the right to consent for the patient unless they legally have the right to do so
what are the clinicians respoonsiblities when assessing capacity
• Keep language appropriate
• Break up information into sections
○ This is why you need longer appointments
• Ask the patient to explain to you what you have discussed with them
• Assessing retention - ask the patient at another appointment
After going over the treatment plan, if it Is not an emergency, ask the patient to come back and assess them again to check they have understood exactly what you are planning to do and its relevance
what are the 5 key principles of the adults with incapcity (scotland) act 2000 part 5 code of practice
5 key principles underpin the Act:
- Benefit
- If it doesn’t benefit the patient and it just benefits you then you cannot do it - Minimum necessary intervention
- Take account the wishes of the adult
- Maybe the patient doesn’t want the tooth saved, doesn’t want to go through endo treatment ~ they just want the tooth out - Consultation with relevant others
- If you can’t find out what they want ~ ask family / friends / carers - Encourage the adult to exercise ‘residual capacity’
- Important
explain the principle “benefit”
- Any treatment must benefit the patient
- Without treatment that benefit would not be possible
- Any intervention must improve or enhance their life
- Once you’ve treated them they must feel better as a result
explain the principle “minimum necessary intervention”
• Treatment shall be the least restrictive option in relation to the freedom of the adult
○ Ie you do the least that is required to get the patient out of pain and comfortable
- We must always seek to avoid the most invasive treatments, when simpler alternatives are available and likely to be successful
- It does not refer to the simplest or least complex solution
explain the principle “take account of the wishes of the adult”
Present and Past Wishes
• We must try and find out what the patient previously (or currently) wanted regarding their dental treatment
• Are there relatives or close friends who can help us find out?
explain the principle “consultation with relevant others”
- We may not know the patient that well
- The patient’s family, friends or other people of relevance are likely to know the person much better
- Relevant other should be consulted with regard to what they think the patient would have wanted
who should be consulted
• The nearest relative and primary carer of the adult
○ Might be the same person
○ Could be different people - this is also fine speak to as many people as you want
• Any guardian, continuing attorney or welfare attorney of the adult who has powers relating to the proposed intervention
○ Guardian is legally appointed
- Any person whom the sheriff decides
- Any other person appearing to the person responsible for authorising or effecting the intervention to have an interest in the welfare of the adult o r in the proposed intervention
explain the principle “encourage residual capacity”
We must identify if there are any decisions which the patient can make for themselves
In so far as it is reasonable or practicable to do so, encourage the adult to exercise whatever skills he or she has concerning property, financial affairs or personal welfare as the case may be, and to develop new such skills
what are the different powers of attorney types
Continuing power of attorney
Welfare power of attorney
who appoints the power of attorney
Granted by the adult while they still have capacity
