Capacity and consent

Question 1

To have capacity you must be able to do what ?

Answer 1

• Understand the information needed to make a decision and the consequences of refusal
• Retain the information long enough to make the decision
• Weigh up the information to make the decision
• Communicate the decision

Question 2

What are the 5 principles of the MCA ?

Answer 2

1. A presumption of capacity
   * Every adult is assumed to have capacity unless proved otherwise
2. Individuals should be helped to make their own decisions
   * Before anyone concludes that they cannot do so
3. Individuals retain the right to make eccentric or unwise decisions
4. Anything done on behalf of people without capacity must be in their ‘best interests’
5. Least restrictive intervention
   * Anything done for or on behalf of people without capacity should be the least restrictive of their basic rights and freedoms.”

Question 3

When acting within a patients best interest, what do you need to take into account ?

Answer 3

• Advanced decisions - Also known as advance decision to refuse treatment (ADRT) or a living will - Can include life-sustaining treatment e.g. CPR, ventilation, antibiotics
• Advanced statements - Written statement that sets down preferences, wishes, beliefs and values regarding future care
• Lasting power of attorney (LPA) A legal document that lets the ‘donor’ appoint one or more people (attorneys) to help them make decisions or to make decisions on their behalf.
• If no one to speak on their behalf an independent mental capacity advocate (IMCA) may be appointed.

Question 4

WHat is the Gillicks competence ?

Answer 4

• Children under 16 can consent if they have sufficient understanding and intelligence to understand what’s involved in the proposed treatment.
• Demonstrate sufficient understanding and knowledge of the treatment and the process(es) it involves, awareness of the benefits and risks, as well as the alterative option(s).
• The medical professional should further rule out any undue influence in pursuing said treatment, and check if there are any fluctuations in capacity.

Question 5

What is the Frasers guidlines ?

Answer 5

Relate specifically to issue of contraception
They state that a doctor can give contraceptive advice and treatment without parental consent, provided the doctor is satisfied:
1. That the young person will understand the professional’s advice
2. The young person cannot be persuaded to inform their parents
3. The young person is likely to begin, or to continue having, sexual intercourse with or without contraceptive treatment
4. That unless the young person receives contraceptive treatment, their physical or mental health (or both) are likely to suffer
5. That the young person’s best interests require them to receive contraceptive advice or treatment with or without parental consent