Capacity and Competence

Question 1

What must consent be to be valid?

Answer 1

• Informed
• Voluntary
• Capacitous

Question 2

What presumption does the GMC say you must start from in regards to an adult patient and their capacity?

Answer 2

You must start from the presumption that every adult patient has capacity to make decisions about their treatment care

Question 3

What is the two-stage test for capacity?

Answer 3

• Stage 1 = is there an impairment of or disturbance in the functioning of a person’s mind or brain? If so…
• Stage 2 = is the impairment or disturbance sufficient that the person lacks the capacity to make the particular decision?

Question 4

Method for assessing stage 2

Answer 4

• Can the patient:
  > Understand the presented information (only needs to be salient information)
  > Retain the information long enough to make a decision
  > Weigh up the decision (don’t need to reach a conclusion that seems rational to you)
  > Communicate that decision

Question 5

What are temporary factors that could remove capacity?

Answer 5

• Confusion
• Shock
• Fatigue
• Pain
• Drugs
• Panic/fear

Question 6

When does a patient’s decision become irrational?

Answer 6

When it is so outrageous in its defiance of logic or of accepted moral standards that no sensible person who had applied their mind to the question to be decided could have arrived at it

Question 7

5 key principles of the Mental Capacity Act (2005)

Answer 7

• Presumption of capacity
• Support of individuals to make decisions
• Unwise decisions
• Best interests
• Least restrictive option

Question 8

What must you do when deciding what to do for a patient lacking capacity?

Answer 8

• Consult with those close to the patient and other members of the healthcare team and aim to reach agreement with them about what the patient would want
• Consider which option aligns closest with the patient’s needs, preferences, values and priorities
• Consider which option would be least restrictive of the patient’s future options

Question 9

Advanced statement vs decision

Answer 9

• AS = any information the patient feels is relevant to their future care, should they lose capacity
• AD = only refers to decision to refuse certain treatment in specified circumstances

Question 10

What criteria must an advanced decision meet to become legally binding?

Answer 10

• In writing
• Signed by patient
• Signed by witness

Question 11

What is a lasting power of attorney?

Answer 11

Legal document conveying power to make certain decisions to a named person whenever the donor has lost capacity

Question 12

What is the Court of Protection?

Answer 12

Court created by the mental capacity act to make decisions on whether someone has capacity, handle best interests disputes, and rule on questions about deprivation of liberty

Question 13

What is competence?

Answer 13

The ability of a young child to consent to treatment

Question 14

What is a child’s maturity?

Answer 14

Takes into account a child’s experiences and ability to manage influences on their decision making (eg. information, peer pressure)

Question 15

What is a child’s intelligence?

Answer 15

Takes into account a child’s understanding ability to weigh risk and benefit, and consider longer term factors (eg. effect on family life or schooling)

Question 16

What do the Fraser guidelines refer to?

Answer 16

Whether or not someone under 16 can be prescribed contraceptives without parental knowledge

Question 17

The Fraser guidelines

Answer 17

• He/she has sufficient maturity and intelligence to understand the nature and implications of the proposed treatment
• He/she cannot be persuaded to tell her parents to allow the doctor to tell them
• He/she is very likely to begin or continue having sexual intercourse with or without contraceptive treatment
• His/her physical or mental health is likely to suffer unless he/she received the advice or treatment
• The advice or treatment is in the young person’s best interests

Question 18

What should you seek if the child lacks Gillick competence?

Answer 18

• Consent from at least one parent
• Ruling from the court if dispute between parents cannot be resolved informally

Question 19

What decisions can and can’t parents override if their child has Gillick competence?

Answer 19

• Treatment that the child consents for and is seen to be in their best interests CANNOT be overruled by a refusing parent
• A parent CAN consent for treatment that the child will not (should seek ruling from Court of Protection)