safeguarding patients rights Flashcards
In the Mental Capacity Act 2005, who has the greatest decision over treatment for a patient who lacks capacity to make their own decision?
prior to MCA, doctors had greatest say and would include the court if their was a dispute.
when MCA was introduced, lawyers/courts/patients were given a greater role although doctors may argue that they are in the best position to judge.
What are the ethical principles behind the MCA 2005?
- freedom of individuals in society - granted as a right by the law
- human rights - no one can tell you what to think or believe
- autonomy - ability to think, reason and choose how we live our lives
- our choices are individual and define who we are and should not be taken away from us
- accept that individuals sometime make the wrong decision but does not allow someone to take our choice away from us - we learn from our mistakes through living with consequences.
In what ways can patients still have autonomy in MCA 2005?
- advanced directives: make decisions while still have the capacity
- substituted decision making: someone makes decisions for you
- court of protection: make decisions about whether person has capacity to make their own decisions
Explain the principle of Liberalism.
Liberalism basically says that we must support/enable people to make their own decisions and not try to restrict or control people from doing this.
- presumes that everyone has capacity to decide
- must take all practical steps to help
- believes that unwise decisions do not show incapacity to decide for one’s self
- acts done to incapacitated must be done in their ‘best interests’
- least restrictive option should be chosen
- if believe someone is incapable of making own decision, can only do every step to advise them/warn them but cannot force them*
*slippery bridge analogy - if there is a faulty, slippery bridge that someone wants to cross but you know they could die crossing it, you can warn them about the bridge but cannot stop the person from going on the bridge
what points must we bear in mind when deciding whether someone has a lack of capacity?
- lack of capacity due to impairment or disturbance in function of mind or brain
- this disturbance may be permanent or temporary
- capacity is DECISION SPECIFIC - deciding whether someone has capacity relates only to the specific decision at that specific moment in time
- equal consideration must be given to each subject - cannot make assumptions about capacity based on age, appearance or any other unjustified assumption
What must a patient be able to do to be deemed competent/have capacity? (4)
- understand
- retain (information)
- weigh information (communicated to them with appropriate assistance)
- communicate decision
what might cause someone to temporarily have incapacity?
- unconciousness
- fear
- alcohol
- accident
- concussion
- medication
who is the determinator in the assessment of capacity?
someone who wishes to take action - doesn’t have to be a doctor, could be a lawyer
In situations involving life-saving treatment or diagnostic treatment, the patient may be incapable of making their own decisions. Therefore another person must act in accordance with the ‘best interest’ of the patient. Who decides what is best for those who lack capacity?
- patient - by advanced directive made when had capacity
- proxy decision maker = lasting power of attorney (LPA) - someone chosen on behalf of patient
- Court of Protection
- doctor/determinator as per best interests
What must the determinator consider when making a decision for patient’s best interests?
- will the patient regain capacity? can the decision wait?
- must involve patient to maximum extent using ‘practical steps to support’
- past and present patient wishes
- relative beliefs and values
- other factors patient would like to consider if able
- take into account views of anyone named by patient to represent best interests
- decision must NOT be motivated by the desire to bring about death
Under what conditions must an Advanced Refusal be made in order for it to be considered?
- must be in writing
- must be written by patient or at patient’s direction
- must be witnessed in writing
What are the rules for allocating a lasting power of attorney (LPA)?
- LPA must be registered and certified by an independent person
- donor and donee (of power) must be over 18
- donor may place restrictions on power
- donor can provide replacement but donee cannot appoint successor nor delegate authority
What is the role of the Court of Protection?
court to deal with all areas of decision-making for incapacitated, has all the powers of the high court:
- power to make one-off declarations
- power to make substituted decisions
- power to appoint deputies
- power to call for reports
Do Judges make better decisions for patients than doctors?
judges are:
- objective
- impartial
- trained in logical reasoning
- listen to both sides of argument
- not personally involved
- trained to make decisions in others best interests
