Capacity

Question 1

What is capacity?

Answer 1

ability to make decisions

Question 2

What are the 4 parts of capacity?

Answer 2

Understand
Retain
Weigh up
Communicate

Question 3

How do you assess capacity on a practical level?

Answer 3

DECISION SPECIFIC

talk through decision including risks and benefits of both options

ask them to summarise all back to you

then they make a decision and you ask why, looking for evidence they are using the information provided.

Question 4

What happens when there is no capacity?

Answer 4

• If lacks capacity, can decision be delayed until regained?
• If not, decisions made in best interests and in least restrictive manner possible
• Legally burden to show “reasonable belief” in your decision
• Relatives help you establish best interests, but have no legal standing

Question 5

What is lasting power of attorney (for health)?

Answer 5

• Allows patient to transfer their decision making should they lose capacity
• Must be made with capacity and registered

Question 6

What are advance decisions?

Answer 6

• Made whilst have capacity, only relevant when loses capacity
• Legally binding decision to refuse specified treatments eg PEG

Question 7

What are Independent Mental Capacity Advocates (IMCA)?

Answer 7

• Needed when nobody willing to advocate for them (no friends/family/neighbours), lack capacity and major medical decision (including DNAR) or long term placement proposed
• Only have the right to speak up for the patient, not to make decisions

Question 8

What are Deprivation of Liberty Safeguards (DOLS)?

Answer 8

• To ensure patient being managed in least restrictive manner possible (provides us with no additional powers but is to protect vulnerable patients from unchallenged institutions)
• Needed when patient lacks capacity, under continuous supervision and control in an institution and not free to leave for significant length of time

Question 9

What happens with driving if you are diagnosed with dementia?

Answer 9

Legally obliged to tell DVLA and insurance co
DVLA will undertake investigation
Ask for GP and psychiatric reports
May need driving assessment
2 possible outcomes:
New licence valid for 1y
Licence revoked

Question 10

What is the difference between MCA and MHA?

Answer 10

MCA - presumption of capacity and principle of autonomy, covers medical treatment for physical and mental conditions, all decisions must be in best interests

MHA - for prevention of risk regardless of capacity, covers only treatment for mental disorder