Mental Capacity Flashcards
What are the principles of the mental health care act?
—> Must be 18 or over
—> Presumption of capacity
—> Right to be supported to make their own decisions
—> Right to make unwise decisions
—> Choosing the least restrictive restrictions
What are the criteria for the mental capacity?
If a person is able to:
Understand
Retain
Weigh
Communicate decision
An impairment in the brain that affects any of these criteria makes them lack mental capacity.
What are important considerations for mental capacity?
Mental capacity may be task specific
It can vary over time
Mental capacity should be based on ability to understand to account for language barriers
Information can be used and weighed depending on the patient’s preferences
What to do if a patient lacks capacity?
—> Use an “advanced decision refusing treatment” (ADRT), which can override what a doctor believe is in their best interests.
—> Lasting power of Attorney makes the choice
—> Decision that is in best interest of patient and the least restrictive option
What are the aspects of advance care planning?
—> Statement of a patient’s wishes
—> Statement of a patient’s refusal to treatment
What is the purpose of ADRT?
Advanced Directive of Refusal to Treatment, which provides patient’s autonomy to not have treatment and are legally binding if valid and applicable. Patients cannot refuse basic comfort and care.
What is the right to make an unwise decision?
Patient should not be assumed to lack capacity solely due to making a decision about their care that a doctor judges as unwise, supporting their autonomy.
What makes an advanced directive valid?
—> Must be 18 and over
—> Specifies the treatment and the circumstances that it applies
—> Must be signed by the person and have a witness for refusal to treatment
—> No external pressure or harassment was made
—> The patient has not said or acted in a way which contradicts their AD
What are the ethical arguments for the use of advanced directives?
—> Supports patient autonomy
—> It is a legal right to refuse treatments
—> Encourages openness and forward planning
—> Patients will be less anxious abut unwanted treatment
What are the ethical arguments against the use of advanced directives?
—> Possibly of coercion/external influence
—> There is difficulty in determining if a patient’s opinion has changed
—> Patients may have difficulty visualising situations vividly and accurately as seeing risk
—> Difficulty determining circumstances are what the patient foresaw
What can affect the validity of an advanced directive??
Prior wishes in the ‘advanced directives’ may be obsolete due to large shifts in psychology from illness like Alzheimer’s disease can lead to an irreversible loss of autonomy
What is the ‘personal identity’ argument against advanced directives?
Advanced directives should be binding only if the person making out the advanced directive is numerically identical as the person who has dementia
The author and the person with dementia are not numerically identical because their psychologies are different
