Mental capacity

Question 1

What are the 4 principles of biomedical ethics (used for making decision in “best interest”)

Answer 1

Autonomy

Beneficence (balence against risk/costs)

Non-maleficence (avoid causing harm that is disproportionate to benefit)

Justice - distribute benefits, costs and risks fairly

Question 2

What are the 5 main principles of the Mental Capacity Act?

Answer 2

Presumption of capacity
Right for individuals to be supported to make their own decisions

It should not be assumed that someone lacks capacity simply because their decision might seem unwise or eccentric

All decision should be made in the patient’s best interest

If someone lacks capacity, all options must be considered before a decision is made. The option chosen should be the least restrictive of their basic rights & freedoms

Question 3

Important questions to determine capacity:

Answer 3

First, do they have impairment/disturbance of the mind? (dementia, delirium, learning disability, mental illness, alcohol/drugs, head injury, neurological disorder)

If yes, does that mean that the person is unable to make the decision at the time it needs to be made?

If yes, to provide evidence, assess these 4 abilities:
Understand
Retain
Use
Communicate

If one is lacking, NO capacity

Question 4

What is an advance directive?

Answer 4

A refusal made by a person, aged >18yrs, with the necessary capacity, of any medical, surgical or dental treatment or other procedure and intended to have effect at any subsequent time when he or she may be without capacity to give or refuse consent

can only refuse, not demand treatment

Question 5

What is an IMCA

Answer 5

Independent Mental Capacity Advocate service

Needed when nobody willing to advocate for them, lack capacity and major medical decision (including DNAR) or long term placement proposed

Only has the right to speak up for the patient, not to make decisions