Session 2: The mental capacity act

Question 1

what are the 5 key principles

Answer 1

1. presumption of capacity in adults (>16)
2. the right for individuals to be supported to make their own decisions (maximise ability to have capacity)
3. eccentric or unwise decisions do not necessarily mean lack of capacity
4. best interests - anything done on their behalf must be in b.i
5. least restrictive intervention - anything done must be least restrictive of rights/freedom

Question 2

how to determine capacity

Answer 2

consider: is there impairment of brain/mental function? is the impairment sufficient to impair capacity to make important decisions? Making a bad choice doesnt mean they lack capacity

Question 3

What is a lasting power of attorney (LPA) involved with

Answer 3

final decision making, persona decision making, welfare decision making including consent to treatment, refusal of life sustaining treatment

Question 4

which adults can appoint a LPA

Answer 4

all adults can as long as they have capacity when they appoint them

Question 5

what must lpa decisions be

Answer 5

they should be made in the best interests of the patient

Question 6

when can the LPA make decisions

Answer 6

when the person has lost capacity

Question 7

who must LPA be registered with

Answer 7

the court of protection

Question 8

what can LPA not do

Answer 8

refuse life sustaning treatment

Question 9

which decisions about adults lacking capacity must go before the court of protection

Answer 9

1. withholding/withdrawing artificial nutrition from pts in persistent vegetative states
2. organ donation or bone marrow transplantation
3. sterilisation for non therapeutic purposes (contraception)
4. some termination of pregnancy
5. major decisions where there is doubt or dispute over the best interests of the pt

Question 10

what must u ensure if a particular action requires restraint

Answer 10

ensure the restraint is proportionate

Question 11

who should you involve in determining what is in the best interests of a pt

Answer 11

carers and loved ones

Question 12

when may life sustaining treatments be lawfully discontinuted

Answer 12

if they are deemed not to be in the best interests

Question 13

what must individuals making decisions on behalf of someone lacking capacity do

Answer 13

must tall all reasonable steps to involve the individual in decision making

Question 14

when do family not have a right to be consulted for all major decisions

Answer 14

if it is an emergency

Question 15

when is an independent mental capacity advocate (imca) appointed

Answer 15

if a person lacking capacity has noone to support them

Question 16

what are imcas involved in

Answer 16

1. decisions relating to serious medication treatment (unless urgent)
2. proposals to move a pt into long term care
3. plant to move a pt into a different hospital/care home

Question 17

what must an imca attempt to do

Answer 17

ascertain the pts beliefs, feelings and values and advocate on their behalf

Question 18

what can a imca do if they belief a pt is being mismanaged

Answer 18

refer a case to the court of protection

Question 19

what can advanced decisions do

Answer 19

refuse treatment but NOT request it

Question 20

when can an advanced decision not refuse treatment

Answer 20

treatment for mental health disorders under the mental health act

Question 21

what does an advanced decision take precedence over

Answer 21

lasting power of attorney unless the lpa was appointed after the ad was made. it also takes precedence over consent by a court appointed deputy

Question 22

do best interests apply in advanced decisions

Answer 22

no

Question 23

what are the conditions that an AD should be written in

Answer 23

the patient must be informed, competent and it must be voluntary

Question 24

does an advanced decision have to be written

Answer 24

no it can be a witnessed oral statement

Question 25

what can an AD not refuse

Answer 25

basic nursing care.

hydration and oral feeding (artificial feeding like n.g tube is considered treatment)

Question 26

when may an AD be inapplicable

Answer 26

if there has been a significant change in circumstance not addressed previously (pregnancy).
if there has been a significant change in prognosis/treatment of the condition since the ad was made

Question 27

when is an AD invalid

Answer 27

if there is competent withdrawal at any point.
if an lpa was appointed after the ad was written and the lpa was given power to make the decision in question.
if the patient acted in a way that is inconsistent with the ad

Question 28

what must advanced decisions to refuse life sustaining treatment be

Answer 28

be signed and in writing
be witnessed and signed by a witness
be specifically stated that the decision is to be respected even if life is at risk
indicate that the maker of the AD has taken into account any changes in circumstances since the decision is made

note: whether a treatment is considered life-sustaining or not is up to the drs discretion

Question 29

what can you do if there is doubt over validity/applicability of an AD in an EMERGENCY

Answer 29

treat the pt

Question 30

what are the conditions for AD to be withdrawn

Answer 30

withdrawal can be oral and at any time provided the pt is still competent. once the pt loses competence, the AD cannot be withdrawn

Question 31

what is the mental health act 1983

Answer 31

a law which sets out who can be admitted, detained and treated in hospital against their wishes

Question 32

when is the mental health act done

Answer 32

if you are putting your own safety or someone elses at risk and you have a mental disorder

Question 33

when can ads be overriden

Answer 33

if the pt is subject to compulsroy treatment under the mental health act

Question 34

what is some controversy relating to advanced directives and the mha 1983

Answer 34

ads are kept to when a pt has lost capacity but can be overridden in some cases if the pt has a mental health condition. this discriminates against pts w mental health disorders