The Mental Capacity Act

Question 1

Lasting Power of Attorney (LPA)- who can it be?

Answer 1

any adult can appoint provided they have capacity- registered with court of protection

Question 2

What is LPA (lasting power of attorney) involved in? (4)

Answer 2

• final decision-making
• personal decision-making
• welfare decision-making including consent to treatment
• refusal of life-sustaining treatment

Question 3

What rule must all decisions by LPA follow?

Answer 3

All decisions made by LPA must be in the best interests of the patient and can be contested. Can only make decisions once patient has lost capacity.

Question 4

Independent Mental Capacity Advocate (IMCA)- who is this?

Answer 4

if person lacking capacity has no one to support them, IMCA should be appointed to support them

Question 5

What is the role of the Independent Mental Capacity Advocate (IMCA)?

Answer 5

• Representing and supporting the patient without capacity so the patient can participate as much as possible in the decision making
• Obtaining and evaluating info about the patient’s condition
• Should attempt to ascertain patient’s beliefs, feelings and values and advocate on their behalf
• Looking for alternative courses of action e.g. different care or housing arrangements
• Obtaining a further medical opinion if necessary

Question 6

What decisions are the Independent Mental Capacity Advocate (IMCA) involved in? (3)

Answer 6

• decisions relating to serious medical treatment (unless urgent)
• proposals to move a patient into long-term care
• plans to move a patient into a different hospital/care home

Question 7

Can the “Independent Mental Capacity Advocate (IMCA)” make decisions on behalf of the patient lacking capacity?

Answer 7

No but they can appeal to the Court of Protection if they believe the decision makers aren’t acting in the person’s best interests

Question 8

Advanced Decisions- what does this mean?

Answer 8

take precedence over LPA (unless LPA was appointed after AD was made). Best interests do not apply. ADs can only refuse treatment, not request it.

Question 9

What big decision can’t be overidden/ refued under Advanced Decisions (AD)?

Answer 9

cannot make an advance decision to refuse compulsory treatment made under the mental health act

Question 10

When is an advanced decision valid?

Answer 10

Only valid when individual loses capacity and it refers to specific treatment in specific circumstance

Question 11

When is an advanced decision valid?

Answer 11

Only valid when individual loses capacity and it refers to specific treatment in specific circumstance

Question 12

What can a patient not refuse/ can not have an AD made against it? (3)

Answer 12

• basic nursing care
• hydration
• oral feeding

Question 13

what is CANH and its relevance?

Answer 13

CANH is clinically assisted nutrition and hydration so things like PEG tube, nasogastric tubes → this counts as medical treatment so doesn’t come under oral feeding, therefore can have an AD made against it

Question 14

When is an advanced decision not valid?

Answer 14

• competent withdrawal
• LPA appointed after AD was written
• patient acted in way that is inconsistent with AD (suggesting they have changed their mind)

Question 15

When does an advanced decision become inapplicable?

Answer 15

• significant change in circumstance not addressed previously (e.g. pregnancy)
• significant change in prognosis/treatment of condition since AD made (e.g. AD long time ago and new treatments available)

Question 16

ADs to refuse life-sustaining treatment must be what?

Answer 16

be signed and in writing, be witnessed and signed by witness, and the maker must indicate they’ve taken into account the circumstances have changed from when the decision was first drafted → this specifically stated decision has to be respected even if life at risk

(Other advance decisions may be made verbally, except life sustaining treatment)

Question 17

When and how can AD (an advanced decision) be withdrawn?

Answer 17

Withdrawal of AD can be oral and withdrawn at any time provided patient is still competent. Once patient loses competence, AD cannot be withdrawn.

Question 18

How does Mental Health Act 1983 affect AD (advanced decision)?

Answer 18

• Advance directives can be overridden if the patient is subject to compulsory treatment under the MHA 1983
• Treatments for mental health disorders cannot be refused by an advance directive

Question 19

When can the Court of Protection appoint a deputy to make advanced decisions?

Answer 19

When there are significant decisions needed to be made on a regular basis that would otherwise probably go to court

Question 20

What can a deputy, appointed to make advanced decisions, not do?

Answer 20

They can never refuse life sustaining treatment

Question 21

What must the decision maker (of an advanced decision) do regarding involving a patient without capacity and their family?

Answer 21

• The decision maker must take all steps to maximise the involvement of the individual in the decision making process
• Unless it is an emergency requiring an immediate decision, the family has a right to be consulted for all major decisions.