Mental Capacity Act 2005 |X

Question 1

What are the 5 principles of the Mental Capacity Act?

Answer 1

The following principles apply for the purposes of this Act.

(1) A person must be assumed to have capacity unless it is established that he lacks capacity.
(2) A person is not to be treated as unable to make a decision unless all practicable steps to help him to do so have been taken without success.
(3) A person is not to be treated as unable to make a decision merely because he makes an unwise decision.
(4) An act done, or decision made, under this Act for or on behalf of a person who lacks capacity must be done, or made, in his best interests.
(5) Before the act is done, or the decision is made, regard must be had to whether the purpose for which it is needed can be as effectively achieved in a way that is less restrictive of the person’s rights and freedom of action

Question 2

If capacity is lacking, what 4 legal documents should you check for?

Answer 2

1. Health and welfare lasting power of attorney
2. Court-appointed Deputy
3. Advanced decision
4. Statement of preferences and values

Question 3

What is a Health and welfare lasting power of attorney?

Answer 3

A legal document that allows someone to choose another person to make decisions on their behalf when they lack mental capacity. In effect they have authority to decide as if they were the person themselves.

Question 4

What is a Court-appointed Deputy?

Answer 4

Someone appointed by the court to make certain decisions on behalf of a person who lacks mental capacity when the person has not made a Lasting Power of Attorney.

Question 5

What is an Advanced Decision?

Answer 5

A document signed by the person and a witness which is made to refuse a specific type of treatment at some time in the future. It is legally binding, so long as it complies with the Mental Capacity Act, is valid and applies to the situation concerned. It will take the place of a best interest decision by other people.

Question 6

What is a statement of preferences and values?

Answer 6

A less formal document that does not have binding legal force, but which helps you know in general terms what the person would have wanted.

Question 7

Ultimately, who decides what is in a patient’s best interests when making a healthcare decision?

Answer 7

A senior responsible professional

Question 8

What is mental capacity?

Answer 8

A person’s ability to make their own choices and decisions

Question 9

When and why might we question capacity in practice (5)?

Answer 9

1. Refusing interventions
2. Patient wants to go home with no support but cannot cope
3. Patient self at risk (seems unaware of own limitations)
4. Patient is confused and does not answer questions appropriately
5. Family members report concerns over patient’s cognitive state

Question 10

How do you assess capacity?
Stage 1
Stage 2

Answer 10

Stage 1: does this person have an impairment of mind or brain?

e. g.
- dementia
- LD
- mental illness

Stage 2. Is the impairment or disturbance sufficient to cause a person to be unable to make that particular decision at the relevant time?

Can the person:

1. Understand info
2. Retain info
3. Weight up consequence
4. Communicate the decision

If they can’t demonstrate 1 or more of the above, this indicates a person lacks capacity related to a particular decision

Question 11

How do you determine best interests (8)?

Answer 11

You must not base the decision on age, appearance, or make unjustified assumptions based on their conditions

1. Consider the person’s wishes feelings, beliefs and values
2. Take into account the views of other people who know the person
3. Do they have any legal documents
4. Encourage participation
5. Provide clear and objective reasons as to why you are acting in person’s best interests
6. Take into account of any views of any Independent Mental capacity Advocate (iMCA)
7. Might they regain capacity?
8. Is there a less restrictive way?

Question 12

What is Deprivation of Liberty Safeguards (DOLS)?

Answer 12

Article 5 of the Human Rights Act states that ‘everyone has the right to Liberty and security of a person. No one shall be deprived of his or her liberty unless in accordance with a procedure prescribed in law

2 questions:
1. Is the person subject to continuous supervision and control?
and
2. Is the person free to leave? - with the focus being not on whether a person seems to be wanting to leave, but on how those who support them would react if they did want to leave

If someone tried to leave, and you would/need to try to stop them, consider DOLS.

Question 13

What does Mental Capacity Act say about restraint and restriction?

Answer 13

The Mental Capacity Act allows restrictions and restraint to beused in a person’s support, but only if they are in the best interests of a person who lacks capacity to make the decisionthemselves. Restrictions and restraint must be proportionateto the harm the care giver is seeking to prevent.

e. g.
- Locks
- Medication
- Close supervision or isolation