LAW 2: The mental capacity act Flashcards
What should you consider when determining capacity?
- any impairment of brain/mental function?
- is impairment sufficient to impair capacity to make important decisions?
- take steps to maximise capacity
who can appoint a LPA?
all adults can appoint one as long as they have capacity when they appoint the LPA
who does the LPA need to be registered with?
court of protection
what is a LPA involved with?
- final decision making
- personal decision making
- welfare decision making (consent to treatment, refusal of life sustaining treatment)
what is important to remember about LPA?
- all decisions made by LPA must be in BI of pt
- LPA can only make decisions once the donee has lost capacity
what are the decisions about adults lacking capacity that must go before the court of protection?
- withholding/withdrawing artificial nutrition from pt in persistent vegetative states
- organ donation or bone marrow transplantation
- sterilisation for non-therapeutic purposes e.g. contraception
- some termination of pregnancy
- major decisions where there is doubt or disbute over the BI of pt
what is included in BI?
- if particular action requires restraint, restraint should be proportionate
- involve carers and loved ones in determining BI
- life-sustaining treatments may be lawfully discontinued if they are deemed not to be in pt BI
- if any doubt, court decleration may be needed
how do you try and support those who lack capacity?
- individuals making decisions on behalf of someone lacking capacity must take all reasonable steps to involve individual in decision making
- unless its emergency, family has right to be consulted for all major decisions
When should an IMCA be appointed?
if a person lacking capacity has no one to support them
what are IMCAs involved in?
- decisions relating to serious medical treatment (unless urgent)
- proposals to move a pt into long term care
- plans to move a pt into a different hospital/care home
what should IMCAs do?
- try to find out pt belief’s, feelings and values and advocate on their behalf
- can refer a case to court of protection if believe their pt is being mismanaged
What does an AD have precedence over?
- take precedence over LPA unless LPA was appointed after AD was made
- take precedence over consent by a court appointed deputy
- BI don’t apply
what is an exception of an AD?
- can’t refuse treatment under mental health act
- can only refuse treatments, not request it
does an AD have to be written?
- when ADs are written, the pt must be informed, competent and must be voluntary
- does NOT have to be written, can be witnessed oral statement
What can an AD NOT refuse?
- basic nursing care
- hydration and oral feeding (artificial feeding considered treatment)
When may ADs be inapplicable?
- significant change in circumstance not addressed previously (e.g. pregnancy)
- significant change in prognosis/ treatment of condition since AD was made
when is an AD is invalid?
- competent withdrawal (at any point)
- LPA was appointed after AD was written and LPA was given power to make decision in question
what are the requirements of ADs that are to refuse life-sustaining treatment?
- be signed and in writing
- be witnessed and signed by a witness
- be specifically stated that the decision is to be respected even if life is at risk
- indicate that the maker of the AD has taken into account any changes in circumstance since decision was made
what happens with an AD in an emergency?
if there is any doubt over validity/applicability of AD, can treat the pt
How can an AD be withdrawn?
- can be oral and withdrawn at any point provided that the pt is still competent
- once pt loses competence, AD cannot be withdrawn
what does the mental health act set out?
- who can be admitted, detained and treated in hospital against their wishes
when is someone detained against their wishes?
if they are putting their own safety at risk or someone else’s AND you have a mental disorder
describe when treatments apply under the MHA
- treatment for mental health disorders cannot be refused by advanced directive
- AD can be overridden if the pt is subject to compulsory treatment under MHA 1983
why is this controversial?
AD are kept to when a pt has lost capacity but can be overridden in some cases if pt has mental health condition
= discriminates against pt with mental health disorders
