Common Ethicolegal Aspects of ELderly Medicine

Question 1

What is mental capacity?

1 - ability to function in day to day life
2 - ability to make informed decisions
3 - ability to taking regular medications
4 - all of the above

Answer 1

2 - ability to make informed decisions
- as per the Mental Capacity Act 2005 Code of Practice, pg.41

Question 2

Does the mental capacity act relate to those under or over 16 y/o?

Answer 2

• > 16y/o

Question 3

Should a patient ever be presumed NOT to have capacity?

Answer 3

• no
• always presume a patient has capacity until proven otherwise

Question 4

Should a patient be presumed as not being able to make a decision if they don’t understand your explanation?

Answer 4

• no
• all practicable steps have been made to help patients make a decision such as translator, writing, asking others to explain

Question 5

If a patient makes in your opinion an unwise decision should they be treated as unable to make a decision?

Answer 5

• no
• as long as they understand the decision they are making

Question 6

Any action made under the Mental Capacity Act 2005 must be in who’s best interest?

1 - clinician
2 - relative
3 - patient
4 - carer

Answer 6

3 - patient
- any decisions made should be the least restrictive option

Question 7

If a patient is deemed to be unable to make an informed decision, we must assess capacity. Which of the following is NOT part of the capacity assessment?

1 - Understand the information relevant to the decision
2 - Request alternative forms of information
3 - Retain that information
4 - Weigh Up the information in making the decision
5 - Communicate their decision

Answer 7

2 - Request alternative forms of information

Question 8

If a patient is deemed to be unable to make an informed decision, we must assess capacity. The following are all part of the capacity assessment. How many of these must a patient fail on to be deemed as lacking capacity?

• Understand the information relevant to the decision
• Retain that information
• Weigh Up the information in making the decision
• Communicate their decision

1 - all 4
2 - >3
3 - >2
4 - just one

Answer 8

4 - just one
- they fail 1 then they are deemed to lack capacity

Question 9

If a patient has been assessed to have capacity for a specific situation, does this capacity refer to all situations?

Answer 9

• no
• capacity is specific to each situation

Question 10

If a patient is unable to make a decision and lacks capacity, then any decision should be in their best interests. Are the patients best interests influence by age?

Answer 10

• no
• must not be influenced by age, medical history or behaviours
• must also include any lasting power of attorney, or Independent Mental Capacity Advocate (IMCA) if they have no other options

Question 11

An advance decision to refuse treatment allows an individual to refuse treatment at a time when they had capacity. Which of the following must be included to this to be valid?

1 - written down
2 - signed by patient
3 - signed by a witness
4 - relevant to specific situation
5 - all of the above

Answer 11

5 - all of the above

Question 12

A lasting power of attorney is when a patient may appoint one of more others to help make decisions at a future point when they lack the capacity to do so. If the patient has capacity at the time, but the lasting power of attorney disagrees, who must the doctor side with?

Answer 12

• the patient
• as long as they have capacity and are aged >18y/o

Question 13

Who CANNOT be a power of attorney for a patient?

1 - >18y/o
2 - teacher
3 - dentist
4 - <18y/o

Answer 13

4 - <18y/o

• Attorneys can be anyone over 18 trusted by the donor, including relatives, friends or solicitors

Question 14

Are all lasting power of attorneys the same?

Answer 14

• no
• several types for specific decisions:
• Health and Welfare
• Property and Financial affairs

Question 15

To be a valid lasting power of attorney, which of the following are required?

1 - registered with the Office of the Public Guardian
2 - donor (patient) must sign
3 - donor (patient) signature must be witnessed by someone other than the attorney
4 - all of the above

Answer 15

4 - all of the above

Question 16

An Independent Mental Capacity Advocate (IMCA) is an Person INDEPENDENT of medical services and can be used if:

1 - patient lacks capacity and has nobody else to advocate
2 - patient lacks capacity but has siblings
3 - patient lacks capacity and has children
4 - patient has capacity but disagrees with the clinical team

Answer 16

1 - patient lacks capacity and has nobody else to advocate

• IMCA gather information to ascertain what patient would want and create a report
• used for change of accommodation, major medical procedures, Deprivation of Liberty Safeguards (DOLS)

Question 17

An Independent Mental Capacity Advocate (IMCA) is an Person INDEPENDENT of medical services and can be used if a patient lacks capacity and has nobody else to advocate. Are these required in emergency settings?

Answer 17

• no

Question 18

The Human Rights Act states that ‘everyone has the right to liberty and security of person, and no one shall be deprived of his or her liberty. However, to protect individuals who lack mental capacity an amendment was made to the law, called Deprivation of Liberty Safeguards (DoLS). Which of the following is NOT part of this amendment?

1 - patient is under continuous direct supervision
2 - patient is not free to leave
3 - patient lacks mental capacity (ability to make a decision)
4 - patient has mental capacity (ability to make a decision)

Answer 18

4 - patient has mental capacity (ability to make a decision)

• the change in the law is to protect those who do not have mental capacity
• any treatment must be in the best interests of the patient with a proportionate response to severity of potential harm and no less restrictive alternative available
• DoLS can be applied for where appropriate

Question 19

A Deprivation of Liberty Safeguards (DoLS) is when a patient needs to have the liberty withdrawn as hey lack mental capacity. This can be applied for. Which of the following are required when applying for a DoLS?

1 - patient identified
2 - form submitted to local governing body (Kent County Council website for patients in Kent)
3 - request is only for a set time period, beyond this period and a further request must be submitted
4 - all of the above

Answer 19

4 - all of the above

Question 20

What is set to replace Deprivation of Liberty Safeguards (DoLS) which has been designed to simplify the authorisation process?

1 - request of free will
2 - liberty request
3 - mental capacity act
4 - liberty protection safeguards

Answer 20

4 - liberty protection safeguards
- will include >16 y/o where before it was >18y/o
- includes care homes, shared accommodation and not just hospitals

Question 21

When taking consent, which of the following is NOT a criteria for taking consent?

1 - consent must be voluntary
2 - consent must be verbal
3 - consent must be informed
4 - consent must be made by patient with capacity

Answer 21

2 - consent must be verbal
- doesn’t have to be verbal

• if a person consents with capacity, their decision must be respected regardless of if you think it is unwise

Question 22

Elder abuse is the intentional act, or failure to act, that causes or risks harm to an older adults >60y/o. Which of the following are forms of elder abuse?

1 - Psychological/emotional abuse
2 - Physical abuse
3 - Neglect
4 - Sexual abuse
5 - Financial abuse
6 - all of the above

Answer 22

6 - all of the above

• Psychological/emotional abuse = hurtful words, shouting or keeping the person isolated
• Physical abuse = physical harm, including restraint
• Neglect = not responding to a person’s needs
• Sexual abuse = forcing a person to watch or engage in sexual activity
• Financial abuse = taking money or belongings from an older adult without permission

Question 23

Elder abuse is the intentional act, or failure to act, that causes or risks harm to an older adults >60y/o. All of the following are forms of elder abuse, but which is most common?

1 - Psychological/emotional abuse
2 - Physical abuse
3 - Neglect
4 - Sexual abuse
5 - Financial abuse
6 - all of the above

Answer 23

1 - Psychological/emotional abuse

• elder abuse is estimated to be as high as 64% in care homes and 15% in the community

Question 24

Which of the following is NOT a sign of elder abuse?

1 - Change in behaviour eg. No longer participating in previously enjoyed activities
2 - Unexplained weight loss
3 - Unkempt appearance
4 - Withdrawn, low mood
5 - Unexplained injuries eg. Bruises
6 - Unsafe living conditions
7 - No longer taking medications

Answer 24

7 - No longer taking medications