B4- W1: Balancing Respect for Autonomy & Best Interests of Adults Flashcards
What is the relationship between autonomy and capacity?
Capacity: Legal concept describing something discrete & decision specific
Autonomy: Ethical concepts describing a contiumn
If you lack capacity in one area does not mean you lack it across the board.
If you lack capacity for a specific decision this do not mean they total lack autonomy- autonomy should still be respected
What is autonomy?
Freedom from contraint/ interferance
Self determination- can persue one’s dires/ goals
What are the conceptions of autonomy
1) Principled/ Moral Autonomy
- Have authority over actions
- According to one’s will & ability to impose/ to reason one’s own moral laws
2) First & Second order desires
- TO want something
- To want to want something
3) Relational autonomy
- Embeds agency & autonomy within social context
- Rejects overly idealised aspects of autonomy
What is the legal requirement to respect autonomy?
1) Tx without consent = battery
2) Person not to be treated as “unable to make a decsion” unless all steps to help him/her make decision have been taken without success
3) Standards of care for provision of information- what would the person want to know
What does the duty of care say?
1) To respect autonomy
2) To act in the patient’s best interests
3) To protect pt from harm
Duty of Care: To respect Autonomy: how can you do this?
1- Treat patients as individuals & respect their autonomy
2- Listen to & respond to their concerns & preferences
3- Give pts information want/ need in an inderstandably way
4- Respect patient’s right to come to a decision
5- Suppoer pt’s in caring for themselves to improve & maintain thier health
Duty of Care: To respect Autonomy: What does this mean in terms of their decision making if they have capacity?
Respect their decision even if this results in harm from a patient
Duty of Care: To respect Autonomy: What must you consider if a person with capacity refuses tx thought to be in their best interests?
1) Is there any reason they may lack capacity
2) Is their decision properly informed
3) Are they being cooerced/ unduely influenced
4) To what extend can you detain/ restrain them to tx in their best interests
Duty of Care: To act in the patient’s best interests- what are the conceptions?
1) Mental state (happiness)
What brings the most happineses for this person
2) Desire fulfillment
Best interests tied to this person’s autonomous choices
3) Objective list
Criteria for achieving wellbeing eg: independance/ relationship etc..
What does the MCA 2005 say about what the person making the decision in best interest should consider?
Present & past wishes & feelings
Beliefs & values that would be likely to influence the decision if they had capacity
Other factors likely to consider
Duty of Care: To protect harm- DOLS & restraint what must be considered?
Brings into conflict the duty to protect them and a person’s autonomy
1) The harm if you do not restrain them
2) The harm if you do restrain them
3) The minimum level of restraint needed
4) Proportionality of restraint to the benefit of Tx
What are the legal framework surrounding restraint & DOLS?
Restraint (short term): MCA
Restraint/ Detain person not at liberty to leave (longter then necessary for immediately necessary tx): DOLS (Deprivation of Liberties Safeguard)
DOLS –> Formal process. Organisational level with independent oversight
Which ADULTS does safeguarding duties apply to?
Give some examples of people who fall into this catagory
Has care/ support needs
AND
At risk or is experiencing abuse/ neglect
AND
Unable to protect themselves because of their care/support needs
eg: elderly and frail, mental disorder, significant physical/ sensory disability, LD, severe physical illness, homless, women due to cultural factors
Safeguarding- What should you do?
1) Identify adults who have safeguarding needs
2) Respond to immediate risks
3) Ax individuals ongoing needs
4) Ax capacity
5) Identify relavent services
6) Seek consent
7) R/v
