Mental Capacity Act 2005

Question 1

What 3 things must consent be in order for a medical decision to be validly consented?

Answer 1

Informed, voluntary, competent

Question 2

Recall the 4 criteria for confirmation of competence

Answer 2

Able to:
Understand
Retain
Weigh-up
Communicate
information that is task-specific

Question 3

What is the principle of equal consideration?

Answer 3

Determination of competence must not be based upon any arbitrary factor such as age, race or gender

Question 4

Recall the 3 steps to follow if an individual lacks capacity

Answer 4

1. Do everything that is practical to enable them to become competent (eg give hearing aid!)
2. If possible and likely, wait for individual to regain competence
3. Make decision based on their best interests

Question 5

What is the Bolam principle?

Answer 5

The principle that states a decision is in a patient’s best interests if numerous doctors agree it is so

Question 6

What is the key flaw with the Bolam principle?

Answer 6

A person’s medical and best interests are non necessarily the same

Question 7

Give an example of a case in which the Bolam principle was used to make a decision

Answer 7

Re F 1990 Mental Health Involuntary Sterilisation

Question 8

Recall 3 key considerations when determining best interests

Answer 8

1. Will the individual regain capacity?
2. What are their past/present beliefs?
3. What are the thoughts and wishes of their family and carers?

Question 9

What is the “least restrictive alternative” principle?

Answer 9

The decision that is in the best interests of the patient achieves the best outcome via the least restrictive intervention on their life

Question 10

Recall 2 legal requirements for life-saving treatment to be ceased

Answer 10

1. No longer in patient’s best interests

2. No motivation to bring about death

Question 11

What is not required for withdrawal of life-saving treatment?

Answer 11

Court order

Question 12

Recall the 2 types of lasting power of attorney

Answer 12

Welfare

Property and affairs

Question 13

Under what body are LPAs registered?

Answer 13

Court of protection

Question 14

What authority does the Court of Protection have?

Answer 14

Part of high court; able to make declarations as to best interests

Question 15

What is the role of a court-appointed deputy?

Answer 15

Make decisions on medical treatments to stop it being brought before the court

Question 16

What elements of the deputy’s role are defined by the court of protection?

Answer 16

Scope and duration of authority

Question 17

What specific thing are court-appointed deputies not able to do?

Answer 17

Refuse life-sustaining treatment

Question 18

Recall 4 medical interventions that must come before the Court of Protection if an individual lacks capacity

Answer 18

1. Refusal or withdrawal of nutrition
2. Some terminations of pregnancy
3. Organ donation
4. Non-therapeutic sterilisation

Question 19

Who is appointed to support those who lack capacity?

Answer 19

Independent Medical Capacity Advocate (IMCA)

Question 20

Recall 3 situations in which an IMCA may be required

Answer 20

There is no one else to make decisions and:

1. There is a serious medical treatment decision to make
2. There are proposals to move someone’s place of care for >8 weeks
3. There are proposals to change where someone is living (>28 weeks)

Question 21

Recall 4 elements of the role of an IMCA

Answer 21

1. Seek to know patient’s wishes and beliefs
2. Gather and evaluate all relevant information
3. Find out alternative courses of action

Question 22

At what point does the remit of an IMCA end?

Answer 22

They cannot make decisions, only advocate for someone if they believe decision-makers are not acting in their best interests

Question 23

When is an advanced decision valid?

Answer 23

In ALL situations, over the LPA and CofP, with the only exception of the mental health act

Question 24

What can advanced decisions be regarding?

Answer 24

Treatment REFUSALS only

Question 25

What are the requirements for an advanced decision to be valid?

Answer 25

Witnessed
Signed
Specifically state that decision is to be respected even if life is put at risk
Evidence the maker has taken into account any changed circumstances

Question 26

What can an advanced decision not refuse?

Answer 26

1. Basic nursing care

2. Oral hydration and nutrition

Question 27

In what 2 circumstances is an advanced decision certainly invalidated?

Answer 27

1. The patient has completely withdrawn from it legally

2. They have since created an LPA with authority to make that decision

Question 28

In what circumstances should the validity of an advanced decision be questioned?

Answer 28

1. There is a significant change in circumstances (eg pregnancy)
2. There is a significant change in prognosis or the available treatment