MCA and MHA Flashcards
Can a child choose not to have a life saving treatment?
No.
In the UK, below the age of 18, you are not allowed to decline life saving treatment. Do not have sufficient capacity.
What are the necessary elements of consent?
consent must be…
- Informed (patient must have an appropriate level of accurate information)
- Competent (patient must have capacity to consent)
- Voluntary (not coerced by relatives, medics, nurses, etc)
Define capacity?
The ability to make a decision, be it personal, financial, or healthcare.
People can have capacity at some points in time but not others, and people can have capacity to make certain decisions but not others (e.g. can choose what to have for breakfast, but not who inherits their money).
What determines decision making for an incapacitated adult?
- Ideally, person makes an Advanced Decision, which is enshrined in law.
- Alternatively they can give someone LPA
- But if neither is in place, doctors are legally bound to make choices that are in best interest AND least restrictive.
What are the main principles of the MCA?
- Presume capacity at all times
- People have a right to make unwise decisions
- Anything done for, or on behalf of someone without capacity should be the least restrictive to their freedom and or rights, and in their best interests
- Capacity assessments should be time and decision specific
- If in doubt, second opinions, legal opinions, ultimate referral to the court.
Describe the two stages of the capacity test?
1) Is there an impairment of, or disturbance in the functioning of the persons mind (neuro or psych).
2) Has it made the person unable to make a particular decision.
- Understand the information presented to them
- Retain information long enough to make a decision
- Weigh up the decision
- Make a decision
- Communicate that decision
How are choices that would lead to end of life handled under the MCA?
Someone has a right to refuse life saving treatment (including the removal of life support).
Someone does not have a right to request life ending treatment.
How and when is a Best Interest decision made?
- When a patient lacks capacity
- Should still discuss with patients and try and ascertain what it is they want
- You can make the BI decision that waiting till someone regains capacity and then letting them choose is in their best interest.
What can ADs be made for?
- Only medical treatments
- Only in the negative to refuse treatment of a specific type
- You can’t make an AD in the positive
- Should really be called anticipatory refusals.
- Patient has to be over 18, can be edited, can be withdrawn orally or in writing so long as that person has capacity.
How does an LPA work?
- Enables a mentally capable person to plan for incapacity
- Can extend to property, healthcare, and welfare
- Decisions must still be guided by best interest requirements.
How does a DOLS work?
Deprivation of Liberties Safeguards.
- MDT assessment, social worker lead
- For patients in hospital or care homes who lack capacity
What does the Mental Health Act essentially allow?
- Used to enforce treatment for mental health conditions
- Core goal = ‘to minimise the undesirable effects of mental illness’
- Naturally works on a best interest/least restrictive principle
- Still involves participation of patient and their next of kin.
What are the criteria necessary for implementing the MHA?
- Patient must have a mental disorder as defined by law
- ….of a certain nature and degree
- They must be at significant risk to their own health or that of others
- There can be no alternative to hospital admission as a means of safeguarding this risk
What does a Section 5(4) allow?
5(4) = Mental Health Nurses have the right to detain an INPATIENT (someone already admitted TO A WARD, A&E DOES NOT COUNT) for up to 6 hours for medical assessment
What does a Section 5(2) allow?
5(2) = Consultants or deputies (including juniors) have the right to detain an INPATIENT for up to 72 hours. No room for appeal
Main aim of this is to allow a formal mental heath act to be completed.
