Capacity Flashcards
How is Capacity defined?
The ability to make a decision
What is the general rule surrounding capacity?
As outlined in the Mental Capacity Act, 2005:
Every adult aged 16 and over must be assumed to have mental capacity, unless it is established that they lack capacity
i.e. everyone must be assumed to have capacity until proven otherwise
What are the 5 main principles of capacity?
As outlined in the Mental Capacity Act (2005):
1) Every adult aged 16 and over must be assumed to have mental capacity, unless it is established that they lack capacity, i.e. everyone must be assumed to have capacity until proven otherwise
2) A person is not to be treated as unable to make a decision unless all practical steps to help him do so have been taken without success
3) A person is not to be treated as unable to make a decision merely because he makes an unwise decision
4) An act done, or decision made, under this Act for or on behalf of a person who lacks capacity must be done, or made, in his best interests
5) If you’re making a decision about treatment for a patient lacking capacity, you must consider whether it’s possible to delay until the person regains capacity.
If this is not possible, regard must be had to whether the purpose for which it is needed can be as effectively achieved in a way that is less restrictive of the person’s rights and freedom of action.
How is capacity assessed?
Two-stage assessment of capacity:
Stage 1 - is there an impairment or disturbance in the functioning of the patient’s mind or brain, whether temporary or permanent
—> if yes:
Stage 2: is the impairment or disturbance sufficient that, even with all practical and appropriate support, the patient is unable to make a particular decision at the time it needs to be made?
The MCA states that someone is unable to make a decision if they cannot do one or more of the following:
1) understand the information relevant to the decision (including foreseeable consequences of whatever decision is made or of failing to make a decision)
2) retain the information
3) weigh up the information to help make a decision
4) communicate this decision (including speech, sign language or simple muscle movement)
A patient failing one or more aspect of this test is deemed to lack mental capacity.
When should Capacity be assessed?
If you have reason to believe that a patient may lack the mental capacity to make their own decision about a treatment or course of action you’re recommending, you need to assess their mental capacity.
Capacity is time and decision specific. This means you should assess a patient’s ability to make a specific decision at the time the decision needs to be made.
Does capacity extend to all procedures?
No, a person’s inability to make a major or complex decision doesn’t mean they can’t make a smaller or simpler decision and vice versa.
For instance, an individual with learning difficulties may be able to consent to having blood taken but may not be able to consent for a colonoscopy.
Therefore capacity needs to be re-assessed for each procedure/investigation.
What do you do if you’re unsure whether someone has capacity or not after you have assessed them?
Ask the nursing staff about the patient’s ability to make decisions
Involve colleagues with more specialist knowledge, e.g. psychiatrist or a neurologist
Consult the clinical ethics team
Seek legal advice as a court may need to make the decision
How do you deal with a patient who lacks capacty?
In making decisions on behalf of the patient, the doctor should take account of a wide range of issues including:
- Whether the pt has signed an advanced directive stating how they want to be treated in situations when he can’t give informed consent
- The views of any individuals who are legally representing the patient or whom the patient has said they wanted to involve
- The views of any individuals close to the patient and may be able to comment on their beliefs, values and feelings (i.e. relatives)
- Whether the lack of capacity is temporary or permanent
Who makes the final decision if the pt loses capacity and does not have an advanced directive in place?
The doctor makes management decisions for the patient. Legally, relatives and others only have an advisory role.
If there are disagreements between the doctor and the rest of the team, or between the medical team and those close to the patient, it is important to seek conflict resolution through negotiation.
Useful resources could include more experienced colleagues, using mediation services, or independent advocates. In cases of more severe disagreements, legal advice should be sought and a court decision may be needed.
