Mental capacity act Flashcards
What is the mental capacity act for
It provides a statutory framework for people who lack capacity to make decisions for themselves, or who have capacity and want to make preparations for a time when they may lack capacity in the future.
What are the 5 principles of the MCA
(For capacity):
- Presume Capacity
- Practicable support
- Unwise decisions
(Lack capacity):
4. Best interests
5. Less
restrictive
When would you be called to understand if someone lacks capacity
The Act’s starting point is to confirm in legislation that it should be assumed that an adult (aged 16 or over) has full legal capacity to make decisions for themselves, UNLESS it can be shown that they lack capacity to make a decision for themselves.
The person’s behaviour or circumstances raise doubt as to whether they have the capacity to make a decision
Concerns about a person’s capacity have been raised by someone else; for example, a family member or a healthcare worker.
Can an individual with capacity refuse medication? What if the treatment is in their best interests?
Absolute right to refuse medical treatment even if the proposed treatment is clearly in their best interests (ensure patient has had all information required for informed CHOICE)
Who can consent on behalf of a competent adult
No one can consent on behalf of a competent adult
T/F an unwise decision by a competent adult can be overturned by a doctor
F… a competent adult has the right to make unwise decisions
How is decision making capacity maximised
INFORMED consent
What must a person have to give valid consent or permission
Information about the decision
Free choice to make the decision without being unreasonably pressured or forced
The Mental Capacity to be able to consent or refuse
What must we explain to help someone decide whether or not to consent
why the care or treatment is needed
the options available and what they entail.
what is likely to happen if the person does consent (Risks associated)
what is likely to happen if the person refuses the care or treatment
What is the 2 stage test of capacity
Does the person have an impairment, or a disturbance in the functioning, of their mind or brain?
Is the impairment or disturbance sufficient to impair capacity to make a decision?
Give some examples of impairment/disturbance in functioning mind/brain
Cognitive impairment Dementia Delirium – acute confusional state Some mental health conditions Drug/alcohol intoxication (or withdrawal!)
What must a person be able to do to make a decision
- Understand
- Retain
- Weigh up and balance
- Communicate back
What is meant by understand the decision
Understand the decision to be made and the information provided about the decision. The consequences of making a decision must be included in the information given.
What is meant by retain infromation
Retain the information – a person should be able to retain the information given for long enough to make the decision. If information can only be retained for short periods of time, it should not automatically be assumed that the person lacks capacity. Notebooks, for example, could be used to record information which may help a person to retain it.
treating)
What is meant by weigh up and balance
Weigh up and balance Use that information in making the decision – a person should be able to weigh up the pros and cons of making the decision. (eg risks of treating vs risk of not
What is meant by comminicate decision
Communicate their decision – if a person cannot communicate their decision – for example, if they are in a coma – the Act specifies that they should be treated as if they lack capacity. You should make all efforts to help the person communicate their decision before deciding they cannot.
What is fluctuant capacity
Capacity can be partial, temporary and change over time
Is the person likely to regain capacity, and if so can the decision wait until they have capacity?
……
What condition must be met to protect you from liability if an action is used to restrain somebody
The person taking action must reasonably believe that restraint is necessary to prevent harm to the person who lacks capacity, and
The amount or type of restraint used and the amount of time it lasts must be a proportionate response to the likelihood and seriousness of harm
What does best interests mean
Unless there is a valid and applicable Advanced Directive then decisions made on behalf of a person lacking capacity must be in the person’s best interests, whoever is making the decision
Carers
Healthcare professional
Court
Court appointed Deputy
What is an independent mental capacity advocate.
The IMCA is an advocate NOT the decision maker
What does the IMCA do
be independent of the person
represent the person to work out whether the proposed is in the person’s best interests
provide information to help identify the person’s best interests
challenge decisions which appear not to be in best interests
T/F IMCAs are not allowed access to healthcare records
F.
IMCAs have the right to see relevant healthcare and social care records
When must an IMCA be instructed
An IMCA must be instructed for people lacking capacity who have no-one else to support them when:
- Making decisions about serious medical treatment
- When proposing/changing accommodation in hospital or a care home, and:
the person will stay in hospital > 28 days OR
they will stay in the care home > 8 weeks
When is the exception for when IMCA is needed
The only exception is urgent decisions
What is an advanced directive
In England and Wales, people above the age of 18 may make an advance directive under the Mental Capacity Act 2005.
This is only for an advance refusal of treatment for when the person lacks mental capacity
What makes the advanced directive legally binding and valid
To be legally binding, the advance decision must be specific about the treatment that is being refused and the circumstances in which the refusal will apply.
To be valid, the person must have been competent and understood the decision when they signed the directive.
What must happen if the advanced directive relates to refusal of life-proloniging treatment
Where the patient’s advance decision relates to a refusal of life-prolonging treatment this must be recorded in writing and witnessed.
What must the advanced directive request be to be valid
- A refusal of care (e.g. Ventilation/CPR/certain medications)
- Competent, informed and voluntary
- Treatment specific
What must life sustaining decisions be
Written
Signed AND witnessed
Clearly state that decision applies even if life is at risk
What makes you question the current applicability
Current situation:
Has the prognosis/treatments changed since the AD was made?
Have there been children since the AD was made? Or major life events?
Has there been a significant and lasting change in beliefs since the AD was made?
What is a power of attorney
A power of attorney is a legal document that allows another person authority to make a decision on another’s behalf
Under a power of attorney, the donee can make decisions that are as valid as one made by the donor
Decisions made by an LPA must be in the person’s best interests
What are the 2 types of LPA
Welfare; Property and Affairs
When can the LPA not be used
If the person has capacity the welfare LPA cannot be used
What are deprivation of liberty safeguards
Deprivation of Liberty Safeguards (DoLS) provides protection for vulnerable people who are in hospitals or care homes in circumstances that amount to a deprivation of their liberty and who lack the capacity to consent to the care or treatment they need.
When should DOL be used
Should be avoided whenever possible
Should only be authorised in cases where it is in the relevant person’s best interests and the only way to keep them safe
Should be only for a particular treatment plan or course of action
Should be for as short a time as possible
What is the acid test
Test is used to determine whether a person is being deprived of their liberty?
When is somebody being deprived of their liberty
The acid test states that a person is deprived of their liberty if:
They are subject to continuous supervision and control and
Are not free to leave
What must be done before you express an opinion on a person’s capacity
The Mental Capacity Act Code of Practice stipulates that professionals should never express an opinion on a person’s lack of capacity without carrying out a proper examination and assessment
What is the legal status of an unborn child
An unborn baby has no legal status and cannot be murdered
T/F there is a legal duty to report serious crime
F
