Capacity Assessment, MCA and DOLS Flashcards
What is a 2 stage capacity assessment?
1: Do they have evidence of a disorder of the mind?
2: can they understand, retain and weigh up information and communicate their decision?
How would you practically assess someone’s capacity?
Introduce myself and confirm patient identity
Ask “can you talk me through what’s been going on?”
Assess for impairment of functioning of the mind
Can I just check, how has your memory been at the moment? Is it alright if I ask a few questions to test your memory?
Do you know roughly what time it is? What day of the week it is? What is the date? What year are we in?
Where are we at the moment?
Who am I?
Can they understand, retain, weigh up and communicate their decision?
Do you know what the risks and benefits are you? Can I explain it to you?
Do you remember what we said about risks and benefits? Could you summarise that back to me?
Weigh up – could you explain your thought process behind that decision for me? Remember delusional beliefs can impair someone’s ability to weigh up effectively
How should you present your capacity assessment?
On balance of probabilities this patient does / does not have capacity
They do/do not have evidence of a disorder of the mind
They can / cannot: understand / retain / weigh up / communicate
If someone does not have capacity, what are your options?
Intially I would apply the Mental Capacity Act, acting in their best interests and choosing the least restrictive option
I would look at their notes for any advance directives or advanced care plans to try and uphold their wishes as best I could
See if they have anyone named for Lasting Power of Attorney, consult their next of kin
Continually reassess their capacity as it is decision and time specific
If needed would escalate to DOLs
What are the principles of the mental capacity act?
Principle 1 – A presumption of capacity
Principle 2 – The right to be supported when making decisions.
Principle 3 – An unwise decision cannot be seen as a wrong decision
Principle 4 – Decisions made on a patients behalf should be in their best interests
Principle 5 – Go with the least restrictive option possible
What is DOLS?
Deprivation of Liberty Safeguards
Part of the MCA used to detain people in hospital or care homes against their will, in order to keep them safe
