Capacity

Question 1

Main principles of capacity

Answer 1

Capacity assumed unless shown otherwise
Individual should receive whatever support they require to make own decisions
Individuals have the right to make decisions others may see as unwise or eccentric
Decisions make on behalf of people lacking capacity should be made in their best interest
Interventions on those lacking capacity must be the least restrictive option
Capacity is decision specific
If possibility of capacity returning decision can be delayed

Question 2

Features of assessing capacity

Answer 2

Patient cannot make a decision due to condition of the mind or brain
- dementia, delirium, learning disabilities, severe depression, alcohol use
Patient cannot understand, retain, weight up or communicate information relevant to the decision

Question 3

Features of advanced care planning

Answer 3

Advance care planning must be in accordance with the person’s best interest and take into account person’s previous wishes
Previous wishes may be established
- advance statement
- legally binding
- can be formal or informal but should be recorded in patients notes and available to all teams
- views of legal proxy
- legally biding
- verbal statement made by person before capacity was lost
- not legally binding

Question 4

Features of advanced decision to refuse treatment

Answer 4

Must be valid and applicable

• valid = document signed by patient, dated and witness, no evidence that patient has subsequently changed their mind
• applicable - relevant to current situation

Question 5

Features of power of attorney

Answer 5

A person with capacity may appoint another person to make decisions on their behalf when they lose capacity
Can be appointed for property/financial affairs or health/welfare decisions
Must be registered with the Office of Public Guardian before coming into effect

Question 6

Features of independent mental capacity advocate

Answer 6

If person lacking capacity has no effective next of kin, friends or relations to speak on their behalf
Required for serious medical decisions and when a change of residence (care home) is contemplated

Question 7

Features of deprivation of liberty safeguards

Answer 7

People who lack capacity should only be deprived of their liberty when it is in their best interest and in the least restrictive way
- medication given against their will
- staff having complete control over patient’s care or movements
- staff making decisions about patient, including assessments. treatments and visitors
Nurse in charge/home managers must apply to the Court of Protection for authorisation to ensure the loss of liberty is lawful
Safeguards allow for a representative of the person affected