LAW 2: The mental capacity act

Question 1

What should you consider when determining capacity?

Answer 1

• any impairment of brain/mental function?
• is impairment sufficient to impair capacity to make important decisions?
• take steps to maximise capacity

Question 2

who can appoint a LPA?

Answer 2

all adults can appoint one as long as they have capacity when they appoint the LPA

Question 3

who does the LPA need to be registered with?

Answer 3

court of protection

Question 4

what is a LPA involved with?

Answer 4

• final decision making
• personal decision making
• welfare decision making (consent to treatment, refusal of life sustaining treatment)

Question 5

what is important to remember about LPA?

Answer 5

• all decisions made by LPA must be in BI of pt

- LPA can only make decisions once the donee has lost capacity

Question 6

what are the decisions about adults lacking capacity that must go before the court of protection?

Answer 6

• 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

Question 7

what is included in BI?

Answer 7

• 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

Question 8

how do you try and support those who lack capacity?

Answer 8

• 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

Question 9

When should an IMCA be appointed?

Answer 9

if a person lacking capacity has no one to support them

Question 10

what are IMCAs involved in?

Answer 10

• 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

Question 11

what should IMCAs do?

Answer 11

• 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

Question 12

What does an AD have precedence over?

Answer 12

• 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

Question 13

what is an exception of an AD?

Answer 13

• can’t refuse treatment under mental health act

- can only refuse treatments, not request it

Question 14

does an AD have to be written?

Answer 14

• 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

Question 15

What can an AD NOT refuse?

Answer 15

• basic nursing care

- hydration and oral feeding (artificial feeding considered treatment)

Question 16

When may ADs be inapplicable?

Answer 16

• significant change in circumstance not addressed previously (e.g. pregnancy)
• significant change in prognosis/ treatment of condition since AD was made

Question 17

when is an AD is invalid?

Answer 17

• competent withdrawal (at any point)

- LPA was appointed after AD was written and LPA was given power to make decision in question

Question 18

what are the requirements of ADs that are to refuse life-sustaining treatment?

Answer 18

• 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

Question 19

what happens with an AD in an emergency?

Answer 19

if there is any doubt over validity/applicability of AD, can treat the pt

Question 20

How can an AD be withdrawn?

Answer 20

• can be oral and withdrawn at any point provided that the pt is still competent
• once pt loses competence, AD cannot be withdrawn

Question 21

what does the mental health act set out?

Answer 21

• who can be admitted, detained and treated in hospital against their wishes

Question 22

when is someone detained against their wishes?

Answer 22

if they are putting their own safety at risk or someone else’s AND you have a mental disorder

Question 23

describe when treatments apply under the MHA

Answer 23

• 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

Question 24

why is this controversial?

Answer 24

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