Capacity Flashcards
Briefly differentiate between implied and expressed consent
Consent can be implied (the patient does not object to, and co-operates with the procedure, e.g. sticking their arm out when approached with a blood pressure cuff) or expressed (verbal or written permission is explicitly asked for and recorded, often on a consent form).
What is capacity?
Mental capacity is defined as one’s ability to make decisions. Capacity can involve consent about personal welfare , healthcare and financial decisions .
What does it mean that capacity is time and decision specific?
Mental capacity is time specific and decision specific:
- Time specific : person may lack capacity at one point in time but may have capacity at another point in time. If the lack of capacity is likely to be temporary, e.g. delirium, it may be possible to delay the decision until the person has recovered.
- Decision specific : may have capacity to consent for one decision but not for another (e.g. may have capacity to consent for a simple endoscopy but not for a more complex surgical procedure which poses greater risks, such as a hemicolectomy).
The nature of psychiatric disorders means that patients may refuse treatment. Situations where treatment can take place without consent can be divided into 3 broad areas.
What are these 3 areas?
The nature of psychiatric disorders means that patients may refuse treatment. Situations where treatment can take place without consent can be divided into three broad areas:
- Treatment under the Mental Capacity Act
- Treatment under the Mental Health Act
- Treatment authorised by a court
What is The Mental Capacity Act (2005)?
A person may lack capacity to make a decision for a variety of reasons, e.g. dementia, delirium, intellectual disability, neurological disorder.
The Mental Capacity Act (MCA) aims to identify those people who may lack capacity to consent to or refuse treatment and to protect them. The MCA applies to England and Wales only and failures to comply with the Act are potentially criminal offences.
When should a lack of capacity be suspected?
When to suspect a lack of capacity:
- Cognitive impairment, e.g. dementia
- Abnormal behaviour
- Refusing treatment
- Delirium
What are the 5 key principles of The Mental Capacity Act (2005)?
Best Interests: decisions made on behalf of the patient must be in their best interests.
Help to make decisions: people must be given all appropriate help before anyone concludes that they cannot make their own decisions e.g. use of interpreters and multiple times (as capacity may fluctuate).
Eccentric or unwise decisions are allowed. Capacity is determined by the way in which a decision is made and not the decision itself. Therefore, it does not matter how unwise the decision is.
Least restrictive intervention: decisions made on the patient’s behalf should be the least restrictive option.
Presumption of capacity: capacity is assumed to be present until proven otherwise.
What is the role of lasting power of attorney?
This allows a person with capacity to appoint an attorney (usually a relative or close friend) to make future decisions on their behalf if they lose capacity.
There are two types of lasting power of attorney:
- Property and affairs deals with property and financial affairs
- Personal welfare deals with decisions about healthcare, living conditions and location
Briefly describe advanced care planning
Advance care planning is a process that allows patients to make decisions about their future care. It takes the form of making an advance statement or an advance decision to refuse treatment, or appointing a lasting power of attorney.
What is an advance decision or advance directive?
An advance decision or advance directive is a legal document with a specific refusal of treatment in a predefined future situation (where the person would have lost capacity) that is signed by the patient and witnessed. Advance decisions permit a person to refuse treatment but not demand it. They do not allow patients to refuse basic care needs such as food and drink by mouth or basic hygiene. Persons writing an advance decision should have capacity at the point of writing it.
What is an advanced statement?
An advance statement (made verbally or written ) allows the patients to make general statements about their wishes and preferences for the future, if they were to lose capacity.
Briefly differentiate between an advance decision and advance statement
An advance decision only concerns refusing certain treatments. An advance statement can also be used to express other wishes and preferences not directly related to care, e.g. stating food preferences. Advance statements are not legally binding like advance decisions.
What is Deprivation of Liberty Safeguard (DoLS)?
The aim of DoLS is to make sure that people in care homes, hospitals and supported living, who lack capacity, are looked after in a way that does not inappropriately restrict their freedom.
When a hospital or care home identifies that a person who lacks capacity is being, or risks being deprived of their liberty, they must apply for an authorisation of deprivation of liberty.
What is an Independent Mental Capacity Advocate (IMCA)?
An IMCA is someone appointed to support a person who lacks capacity but has no one to speak on their behalf (i.e. no next of kin or lasting power of attorney).
The IMCA makes representations about the person’s wishes, feelings, beliefs and values, while bringing to the attention of the decision maker all factors that are relevant to the decision.
