Mental Capacity Act(lecture)

Question 1

WHat is the mental capacity act used for

Answer 1

• Designed to protect and empower individuals who may lack the mental capacity to make their own decisions about their care and treatment • When: o Before a patient needs to make a decision and before a patient needs to give consent o Informed, voluntary consent and as long as the patient is competent

Question 2

What are the rights of a competent adult

Answer 2

• Absolute right to refuse medical treatment even if the proposed treatment is clearly in their best interests • No one can consent on behalf of a competent adult • Right to make unwise decisions

Question 3

How to Maximise capacity

Answer 3

• Right information • Time to process/weigh up • Aids (glasses, hearing aid, interpreter, braille, etc)

Question 4

What is the MCA Statutory Principle

Answer 4

Presumption of capacity • Freedom to make unwise choice • Capacity must be decision specific • Decision making capacity must be maximized

Question 5

What are the two stages of a Functional assessment of capacity

Answer 5

• 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

Question 6

WHat are the four things a person with capacity should be able to do to make a decision

Answer 6

• Understand • Retain • Weight up and balance • Communicate

Question 7

What criteria must an advanced directive follow to be valid

Answer 7

• Persons writing an AD MUST be o 18 years and older o Have mental capacity • The request MUST be o A refusal of care o Competent, informed and voluntary o Treatment specific.

o NOTE: The request CANNOT refuse basic nursing care, oral feeding/hydration

Question 8

What are the criteria for life-sustaining decisions

Answer 8

NOTE: Life sustaining decisions must be: • Written • Signed AND witnessed • Clearly states that decision applies even if life is at risk o Otherwise, could be oral

Question 9

What criteria make an advanced directice applicable

Answer 9

• Current situation: o Has the prognosis /treatment changed since the AD was made o Have there been children since the AD was made? o Has there been a significant and lasting change in beliefs since the AD was made? • Healthcare professional not liable if they o Stop/withhold treatment due to reasonable belief that a valid AD exists o Treat a person and have taken reasonable steps to find out if a valid AD exists • NOTE: Cannot refuse treatment under Mental Health Act or basic nursing care

Question 10

What are the criteria for the withdrawal of an advanced directive

Answer 10

• Withdrawal can be at any time provided the individual is still competent • Withdraw can be oral or in writing • Once capacity is lost the AD cannot be withdrawn

Question 11

Who are the proxy decision makers in regards to lack of mental capacity

Answer 11

• Lasting Power of Attorney • Court of protection • Court Appointed Deputy

Question 12

What is a Lasting Power of Attorney

Answer 12

• A POA is a legal document that allows another person authority to make a decision on another’s behalf • Under a POA, the done can make decisions that are as valid as one made by the donor • Decisions made by an LPA MUST be in the person’s bes interest

Question 13

What is the criteria for the lasting POA

Answer 13

• Donor must be over 18 • Must have capacity • Two types of LPA: o Welfare o Property and Affairs • If the person has capacity, the welfare LPA cannot be used • Donor can specify limits to attorney decision-making o Must be written and signed o Must be registered with Office of Public Guardian

Question 14

What are the roles and rights of the LPA

Answer 14

LPA for welfare included: • Rights of access to personal information • Complaints about the donor’s care or treatment • Where the donor should live and with whom • Who the donor may have contact with • The donor’s day-to-day care • Consent/refusal of medical treatment • Life-saving treatment (must be specified)

Question 15

What is done to a person lacking capacity in the absence of an AD

Answer 15

Best Interests • Unless there is a valid and applicable AD, then decisions made on behalf of a person lacking capacity MUST be in person’s best interest, whoever is making the decision o Carers

o Healthcare professional o Court o Court appointed Deputy o Donee of LPA

Question 16

What do statutory requirements state in regards to someone lacking capacity

Answer 16

State that all reasonable steps should be taken to: o To encourage participation by the individual o Determine if the lack of capacity is temporary – can the decision reasonably wait? o Find out the person’s views including: ▪ Past and present wishes and feelings ▪ Any beliefs and values ▪ Any other factors the person themselves would be likely to consider

Question 18

Describe the role of the IMCA

Answer 18

• The IMCA is an advocate NOT the decision maker • The IMCA will: o be independent of the person o represent the person to work out whether the proposed is in the person’s best interests o provide information to help identify the person’s best interests o challenge decisions which appear not to be in best interests • IMCAs have the right to see relevant healthcare and social care records Important • An IMCA must be instructed for people lacking capacity who have no-one else to support them when: o Making decisions about serious medical treatment o When proposing/changing accommodation in hospital or a care home, and ▪ the person will stay in hospital > 28 days ▪ they will stay in the care home > 8 weeks o The only exception is urgent decisions

Question 19

The Mental Capacity Act provides the legal framework for decision-making for patients who lack capacity T/F

Answer 19

T