Bringing up making an Advanced Care Plan Flashcards
I’ve heard someone mention Advance Decisions and Advance Statements. Could you tell me what they are please?
a. Advance statements – expressions of general attitudes and wishes, used to inform clinical decision making when we are unable to ask the PT.
- Advanced decisions
a. Can only refuse treatment
b. Over 18 only
c. I f Valid and applicable must be legally binding:
i. Circumstances are the ones specified – not significantly changed
ii. Not overridden by more recent Advanced decisions
iii. Not overridden by LPA which covers that decision in question and was appointed after the Decision.
d. BUT advanced refusals of life-sustaining treatment – writing, signed & witnessed
Is there anything else you think I could do to make sure that my wishes are respected by the doctors?
advanced statement
advanced decision
LPA
whats an LPA
Lasting power of attourney – means someone can make the legal life and death decisions for you if you lose capacity. only if they lose capacity.
can be for financial decisions or medical or both.
- Lasting power of attorney
a. Person with capacity may give done – LPA to make decisions when they lack capacity
b. Range of decisions –specified
c. Discontinuing life sustaining treatment – only if there is express provision for this
what is an advanced care plan
Advance care plan = plan made when person has capacity about what should happen if lack of capacity
Voluntary, patient focused and led process
Helps individuals with capacity anticipate how their condition may affect them in the future
Records choices about care/treatment
Including Advance Decision to refuse a treatment in specific circumstances
Referred to if capacity lost
Advance care planning measures should be considered in ‘everyone affected by life limiting or life threatening illness’
difference between withholding and withdrawing treatment legally
From a legal point of view witholding treatment is the same/ equivalent to giving a treatment and then removing it.
You need permission to withdar treatment form persistent vegetative state patients. It is a statutory requirement.
Basic care must always be offered: - food and drink - washing - pain relief food and drink can be refused at the time it is offered but not in an advanced directive.
Withdrawing treatment on the basis that it is not in their best interests is DIFFERENT to withdrawing treatment in order to bring about death.
In all instances, document everything, talk to other people and professionals to check you’re making the right decision, and make it clear that anything you are doing is a decision made in the patients best interests.
Conscientious objection – if you disagree with the PT you can withdraw yourself but have to ensure continuation of care with another suitable colleage
A competent patient’s consent is necessary to continue treatment
A competent patient’s refusal of treatment must be respected, even if it will result in death
intro steps to the station
1) Wash hands and introduce yourself
2) Check correct patient
3) Ask patient to tell you a little bit about what has been happening with them
4) If they do not realise that they may lose capacity to make decisions then sensitively point this out to them
5) Ask them if they have thought about how they would like their end of life care to be managed. Eg would they want to be maintained on an artificial ventilator if they were no longer able to breath by themself.
after asking them if they’ve thought about how they would like their end of life care to be managed. then what - what are their options?
6) Introduce to them the option of advanced care planning. Eg As your condition progresses and you can no longer make your own decisions there are several ways to have planned your care in advance so that you get the treatment that you want. This is called advanced care planning.
7) Explain to them their options:
a. LPA – could pick spouse, can deny treatment but cannot request it. Have to go to court for LPA (~£130)
b. Advanced decision, sometimes called a living will –must be signed, dated and witnessed if to deny life sustaining treatment.
i. Not need a lawyer but it is recommended.
ii. Say even when it has been written the patient can change their mind etc.
iii. Specifically if the patient is admitted and changes their mind (and still has capacity) then the advanced decision will not be used.
c. Advanced statement – can only state. Not legally binding.
d. Other things to consider but which are probably not relevant to in an OSCE are deputies of the court and an independent mental capacity advocate.
what is Court of Protection & deputies
- Court of Protection & deputies
a. Jurisdiction over the whole MCA
b. Resolves complex or disputed cases
c. Power to appoint a deputy of court
d. Deputies – appointed if court cannot make a one-off decision – make welfare, healthcare & financial matters. CANNOT refuse life-sustaining treatment.
independent mental capacity advocate.
The Mental Capacity Act 2005 introduced the role of the independent mental capacity advocate (IMCA).
IMCAs are a legal safeguard for people who lack the capacity to make specific important decisions: including making decisions about where they live and about serious medical treatment options. IMCAs are mainly instructed to represent people where there is no one independent of services, such as a family member or friend, who is able to represent the person.
