law Flashcards
Mental health act 1983
facilitates preservation of safety of patient and others due to suspected mental illness
- section 136 - removal from public place by police
- section 5(4) - nurses detain until assessment by dotor
- section 5(2)- detention by doctor for 72 hrs for assessment
- section 2 - admission for 28 days for assessment
- section 3 - admission for 6 months for treatment
Misuse of drugs act 1971
controls drugs to prevent non-medical
classification A - C
penalties for possession, supply, production
A = crack cocaine, cocaine, MDMA, herin, magic mushroms
B = amphetamines, cannabis, ketamine
C = anabolic steroids, benzos
Psychoactive substances act 2016
restruct legal highs
any substance capable of production of psychoactive effect
mental capacity act 2005
legislation which empowers and protects people who lack capacity to make their own decisions
capacity = ability to use, understand information to make a decision and communicate that decision i.e. ability to make a decision
capacity is decision specific
5 principles
- capacity is assumed unless proven otherwise
- maximise potential for capacity
- unwise decisions doesn’t equate to lack of capacity
- make decisions in best interests if lacking capacity
- treatment should be least restrictive of rights and freedoms
Assessment of capacity
- does person have impairment of mind or brain
- does impairment mean person is unable to make a specific decision?
- understand relevant information
- retain information
- weigh up information to make a decision
- communicate that decision
good practice includes - encourage participation, find out persons past views, wishes, values, avoid discrimination, re-assess
consultation with others including LPA
Pitfalls in capacity assessment
- diagnosis of cognitive disorder e.g. dementia does not mean patient lacks capacity.
- cognition tools e.g. MMSE are not appropriate for assessing capacity
- capacity is time specific - lacking capacity at one time does not mean they will lack capacity the next. can decision wait?
- capacity is decision specific - lacking capacity for one decision doesn’t mean lacking for all
- has individual been provided with all relevant information
- has ability to communicate been maximised - SLT
- is individual subject to external pressures?
- disputes - case conference, second opinion, independent expert in assessing capacity, support from advocates, mediation, court of protection
resolving disputes about capacity
informal
- settle before serious dispute - communicating effectively, address worries
- setting out options in an easy way to understand
- invite colleagues, independent, advocate
- allow family time
formal
- mediation - independent, help solve problem arising through difficult relationships or communication
- PALS
- court of protection
DOLS
prevent unlawful restrictions to a persons freedom.
applied via local authority
under MCA patient can be restrained if lacking capacity and it is in their best interests
depriving liberty requires DOLS, rarely indicated in ICU as patient too unwell to be considered that they are deprived of liberty
formal authority sought to prevent patient leaving If physically capable
DOLS considerations
formal legal authority is required to deprive someone of their liberty. courts have ruled that concept of DOL applied differently in to context of provision of necessary life sustaining treatment
there is no deprivation of liberty, even if patient can’t consent
- patient is so unwell that they are at immediate risk of dying anywhere other than in hospital
- treatment is delivered the same way as if they had consented
formal authority should be sought
- prevent patient leaving if physically capable
- if circumstances amount to deprivation of liberty, then formal authority sought and care continue to be in best interests
Refusal to accept diagnosis of death using neurological criteria
no statuary definition of death - courts adopt AoMRC
family refusing to accept DNC - challenge to method
dispute –> application to high court to establish whether or not the patient is dead
(not court of protection for best interest or coroner)
application to court in parallel to other forms of mediation
evidence required to support diagnosis of death - confirmation that relevant codes and guidance have been followed, outcome of clinical tests and supporting medical records
if person declared dead by the court - withdrawal of mechanical ventilation must follow
rare when medical consensus of death for court to disagree
maintaining confidence in diagnosis of death using neurological criteria
DNC requires -
1. irreversible structural brain injury
2. confirmation of preconditions to ensure clinical state not treatable or reversible. requires patient to be deeply comatose, apnoeic
3. series of clinical tests to confirm absence of brainstem function
if uncertainty of confounding factors or ability to perform tests, expert advice and consideration of ancillary tests
Red flags in DNC
- < 6 hrs since loss of last reflex
- < 24hrs if cause in anoxic brain injury
- < 24hrs from rewarming following hypothermia
- prolonged fentanyl infusions
- neuromuscular disorder
- steroids in SOL
- decompressive craniectomy
- posterior fossa / brain stem pathology
disability and ICU
person has disability if mental or physical impairment which has substantial long term effect on ability to carry out day to day activities
equalities act 2010, ECHR
- think about process e.g. communication support
- outcome - steps needed to ensure person with disability is able to access critical care on the same basis
- discrimination may occur
steps taken relating to disability
- ensure consistent decision making and coumentation
- treatment decisions in consultation with disabled person
- DNACPR decision must involve person
- DNACPR discussion must involve appropriately interested person if person lacks capacity
- discrimination more likely when decisions about access to treatment are used on quality of life as opposed to survivability
- disabled patients - access to ACP
disclosure of genetic information without consent
- duty of confidentiality continues after patient has died
- circumstances when relevant information about a patient may be disclosed (public interest, protect others from serious harm)
- balance of duty to protect patient vs protect another from serious harm
- English law imposes duty of confidentiality
- depending on cue, clinicians may have duty to consider the interests of an at risk relative
- disclosing information should be under advice from experienced colleague, legal department
