Ethicolegal aspects Flashcards
LO: Describe common legal issues in Elderly Medicine:
What is Mental Capacity?
‘An individual’s ability to make a decision’
(Mental Capacity Act 2005 Code of Practice, pg.41)
LO: Describe common legal issues in Elderly Medicine:
Assess the capacity of adults to make a decision
How is Mental Capacity assessed?
4 things:
UNDERSTAND the information relevant to the decision
RETAIN that information
WEIGH UP the information in making the decision
COMMUNICATE their decision
at that moment (doesn’t mean it lasts or they need memory of decision)
How are decisions made when people lack capacity to make them for themselves?
Usually if someone is unlikely to regain capacity before the decision needs to be made, a decision is made in the person’s Best Interests
What is elder abuse? Why is it important? How is it recognised?
(LO: Outline elder abuse and adult safe-guarding concerns.)
‘An intentional act, or failure to act, that causes or risks harm to an older adult’
60+ in a relationship with an expectation of trust
It’s common: 15% in the community, 64% in care homes, especially women and reduced independence, and finance
LO: Describe common legal issues in Elderly Medicine:
Describe the process as set out in law to protect those who lack capacity to make decisions about their care, including those deprived of their liberty
Mental Capacity Act 2005 provides legal framework to guide clinicians in assessing mental capacity and protect the rights of patients
What/who does the mental capacity act (2005) relate to?
Relates to everyone 16 and over
Intended to enable adults to make their own decisions wherever possible, and to protect those who lack capacity
Capacity is decision-specific
What are the 5 principals of MCA (2005)
1) A person must be assumed to have capacity until it is proven that they lack capacity
2) A person must not be treated as unable to make a decision unless all practicable steps have been made to help them to do so
3) A person is not to be treated as unable to make a decision because they make an unwise decision
4) Decisions made under this Act must be in a person’s best interests
5) The decision should be the least restrictive option
Impairment in functioning of mind/brain may include (give some examples)
Conditions associated with some forms of mental illness
Dementia
Significant learning disabilities
The long-term effects of brain damage
Physical or medical conditions that cause confusion, drowsiness or loss of consciousness
Delirium
Concussion following a head injury, and
the symptoms of alcohol or drug use
what factors should be considered in a “best interests” decision if capacity is lacking?
Person’s past and present wishes
Beliefs and values that would influence decision if had capacity
Views of Lasting Power of Attorney (LPA) or other named person
Consider consulting Independent Mental Capacity Advocate (IMCA)
ALSO: Advanced decision (AD)/ethical research
How can you make an LPA
online /on paper but donor’s signature must be obtained and witnessed by someone who is not being made an attorney
2 types:
Health and Welfare
Property and Financial affairs
To be valid LPAs must be registered with the Office of the Public Guardian (may take 20 weeks, costs £82 per LPA)
what is an IMCA - Independent Mental Capacity Advocate and when re they used
Person INDEPENDENT of medical services who acts on behalf of patient who lacks capacity to make decision and has no-one else to act as an advocate
Used for change of accommodation, major medical procedures, DOLS
Not required in emergencies
what are DOLS: Deprivation of Liberty Safeguards
Procedure in law to protect the rights of an individual who is deprived of their liberty in a hospital or care home without the mental capacity to consent to this
(must be proportionate, best interests and “least restrictive”)
How are DOLs implemented
Hosp/care home must apply to local authority
What are common types of elder abuse? (5)
Psychological/emotional abuse – most common form, includes using hurtful words, shouting or keeping the person isolated
Physical abuse – causing physical harm, including restraint
Neglect – not responding to a person’s needs or withholding medication, food or access to healthcare
Sexual abuse – forcing a person to watch or engage in sexual activity
Financial abuse – taking money or belongings from an older adult without permission
What would you do if you suspect elder abuse?
The Care Act 2014 requires local authorities to protect individuals from abuse and neglect
If abuse is suspected, an ‘adult safeguarding concern’ should be raised
This can be done via the Kent County Council website
NHS Trusts have adult safeguarding leads; individuals who can be approached for advice
what factors can increase the risk of elder abuse?
more common in care homes (64% not 15% in community)
-Women
-functional dependence,
-cognitive impairment,
-poor physical health
-Low income
what three factors are necessary for consent to be valid?
Voluntary
Informed
Capacitous
