Ethics Flashcards
Mental capacity
ability to make decisions and can involve consent about personal welfare, healthcare and financial decisions
Situations where treatment can take place without consent
- Treatment under mental capacity act
- Treatment under MHA
- Treatment authorised by the court
When to suspect lack of capacity
CARD
Cognitive impairment
Abnormal behaviour
Refusing treatment
Delirium
5 principle of MCA
I HELP
best Interest
Help to make decisions
Eccentric or unwise decisions are allowed
Least restricitive option
Presumption of capacity
Types of lasting power of attorney
- Property and affairs
- Personal welfare
Advance care planning
Advance statement or advance decision to refuse treatment or appointing lasting power of attorney
Legal document with a specific refusal of treatment.
Can refuse things but not demand it - cannot refuse basic needs - food / drink etc
Advance statement vs Advance decision
Advance statement is not legally binding unlike decisions
DoLS
Deprivation of liberty safeguard
Make sure people in care homes, hospitals and supported living who lack capacity does not affect their freedom
IMCA
Independent mental capacity act
Someone appointed to support a person who lacks capacity but has nobody to speak on their behalf.
Mental disorder definition
Any disorder or disability of the mind.
It includes, mental illness, personality disorder, LD and disorders of sexual preference, BUT NOT alcohol or drug dependence.
When to use MHA
Revise Our Mental Health Act
Refusal of voluntary treatment
Other options have been considered
Mental disorder -MCA
Harm - risk of
Appropriate treatment - available
Section 2
Admission for assessment
Nonrenewable
Assessment
An AMHP or rarely NR makes application on recommendation of 2 doctors
One of the doctors should be approved under section 12 of MHA
Duration is 28 days
Section 3
Admission for treatment which is renewable
Treatment
6 months
An AMHP or rarely NR makes application on recommendation of 2 doctors
One of the doctors should be approved under section 12 of MHA
Section 4
Used as emergency when section 2 would involve an unacceptable delay.
Emergency
GP, AMHP or NR
72 hours
Section 5(2)
A patient who is a voluntary patient in hospital can be legally detained by a doctor
holding
doctor - responsible clinician
72 hours
5 (4)
Similar to 5 2 but by nursing staff
6 hours
Section 135
A court order can be obtained to allow the police to break into a property to remove a person to a place of safety
Police
Magistrate / police officer
72 hours
Section 136
Someone found in a public place who appears to have a mental disorder can be taken by the police to a place of safety
Police
Police officer
72 hours
Psychiatric inpatient settings
Open ward
Low secure
Medium secure
High secure
Low secure facilities
Less physical security, but more standard than open secure. Often transferred here if other mental health services cannot treat due to challenging behaviour or risk to others
Medium secure facilities
Not as secure as high.
Air locked entrances, unbreakable windows, high nurse to pt ratios with restraint training for staff
High secure facilities
For those who present with an immediate and grave danger to general public because they are violent, unstable or dangerous.
Where does 5 2 not allow
A+E
Admit to ward and then detain.
Or
Use MCA
Requirements for capacity
*understand the information that is relevant to the decision they want to
make
*retain the information long enough to be able to make the decision
*weigh up the information available to make the decision
*communicate their decision by any possible means, including talking, using
sign language, or through simple muscle movements such as blinking an
eye or squeezing a hand.
Reasons to question capacity
If disorder of the mind or the brain.
