Adults with Incapacity Flashcards
What is the Adults with Incapacity (Scotland) Act 2000?
framework for safeguarding the welfare and managing the finances of adults who lack capacity due to mental illness, learning disability or a related condition, or an inability to communicate
What is the aim of the Adults with Incapacity (Scotland) Act 2000?
protect people who lack capacity to make particular decisions, but also support their involvement in making decisions about their own lives are far as they are able to do so
What part of the Adults with Incapacity (Scotland) Act 2000 covers medical and dental treatment?
- Part 5
What is incapacity?
- inability of an adult to enter into legally binding contracts
- person over 16 years
- condition to the extent they cannot understand what a decision involves or make a true choice
- decision has no legal effect
How is capacity assessed?
- presume capacity for all patients
- capacity is decision or action specific
- not all or nothing
- capacity can fluctuate
- may differ throughout the day
- unconscious patient
- commonly seen with dementia patients
- consider residual capacity
- record capacity assessment
- gather evidence from range of sources
- listen carefully to patient
- keep language appropriate
- simple
- no jargon
- chunk and check
- break up information into sections
- ask patient to explain what has been discussed
- check retention
- ask the patient about subsequent appointments
- always leave 24 hours before treatment to allow time to consider options
What does not render someone to have impaired capacity?
- in care
- mental health condition
- difficulties with speech or writing
- addiction issues
- brain injury
- physical disability
- in prison
- neurological condition
- not behaving rationally
- disagree with you
How is incapacity determined
- being incapable of:
- Acting
- Making a decision
- Communicating their decision
- Understanding their decision
- Retaining memory of their decision
What aids are available for communication?
- sign language
- text to speech
- visual aids
- patient information leaflets
- loop systems
- spelling boards
- iPads
How can individuals demonstrate capacity?
- understanding in simple language what the treatment is, its purpose and nature, and why it is being proposed
- understand its principle benefits, risks and alternatives
- understand in broad terms the consequences of not receiving the proposed treatment
- retain information long enough to use it and weigh it in the balance in order to arrive at a decision
What are the 5 key principles that underpin the Adults with Incapacity Act?
- benefit the adult
- treatment must benefit the patient
- without treatment benefit would not be possible
- intervention must improve or enhance life
- minimum necessary intervention
- consider longevity required
- many not be the minimum/simplest treatment possible
- restricts freedom as little as possible
- take into account the wishes of the adult
- what did the patient previously want (also current wants)
- ask patent
- look for a patient passport or care home notes
- heavily restored dentition shows previous treatment
- aesthetic treatment shows investment in mouth
- missing teeth, potentially reluctant to attend dentist
- consult relevant others
- family (primary carer)
- guardian
- legal professionals
- what the patient would have wanted
- encourage the adult to exercise residual capacity
- allow patient to make decisions that they are still able to
- must consider reversibility of the condition
What is proxy?
- a suitable adult substitute decision maker for someone without capacity
What are the three types of power of attorney and which can consent for dental treatment?
- continuing power of attorney
- cannot consent for dental treatment
- welfare power of attorney
- can consent for dental treatment
- combined power of attorney
- can consent for dental treatment
What are the two types of guardianship orders and which can consent for dental treatment?
- welfare guardian
- can consent for dental treatment
- financial guardian
- cannot consent for dental treatment
What is power of attorney?
- granted while a patient has capacity for someone to act on their behalf should the need arise
- dormant until demonstrated needed
- no expiry date (indefinite once capacity lost)
- can be more than one person
- often family member or trusted friend
- organised through lawyer
- does not need to go to court
- registered with the Office of the Public Guardian (OPG)
What is continuing power of attorney?
- financial power of attorney
- only covers financial affairs and property
- cannot consent to dental treatment
