Safeguarding Patients Rights: Incompetent Adults and MCA 2005

Question 1

Who decides what’s best for a patient?:

• pre MCA 2005
• post MCA 2005

Answer 1

Doctor

Court

Question 2

What are the ethical principles behind the MCA 2005?

Answer 2

• freedom of the individual
• human rights
• autonomy
• accept that sometimes individuals make wrong/foolish decision but that doesn’t mean that someone should intervene paternalistically and overuse them

Question 3

In what 3 ways does the MCA 2005 give the patient more autonomy?

Answer 3

1. Advanced directives
2. Introduces concept of ‘substituted decision making’
3. Court of Protection

Question 4

What would deem a patient to lack capacity?

Answer 4

If unable to make decision for self because of impairment/disturbance of function of mind or brain
May be permanent or temporary
Decision specific
‘equal consideration’

Question 5

Unable to make decision  if, on balance of probabilities, pt unable to:
1.
2.
3.
4.

Answer 5

• understand
• retain
• use of weigh up info
• communicate decision

Question 6

What are some causes of temporary incapacity?

Answer 6

unconsciousness
emotional state - fear
alcohol
concussion
drugs

Question 7

If you know the incapacity is temporary, when do you decide to treat the patient?

Answer 7

In the best interests of the patient
If emergency then treat straight away
Can decision wait?

Question 8

Who decided what is beast for those that lack capacity?

Answer 8

Patient - by advanced directives made when had capacity
Proxy decision maker
Court of Protection
Doctor/determinator as per best interests

Question 9

What are advanced refusals?

Answer 9

To apply to life-sustaingin treatment, must be in writing, signed by pt or at pts direction and witnessed in writing
If Dr suspects AR exists, must make reasonable efforts to find it, time permitting but can act in an emergency

Question 10

What are LPA’s?

Answer 10

Lasting Powers of Attorney
By proxy substiiteud healthcare decision making introducted
Extends to welfare and healthcare not just property and welfate
LPA must be registered and certificated from an independent person
Doner and donee must be over 18
Donor may place restrictions on power
Donor can provide for replacement but donee cannot appoint successor nor delegate authority

Question 11

What do the court of protection do?

Answer 11

New 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
- substituted decisions 
- appoint deputies
- call for reports

Question 12

What are the key things to do when dealing with incapacitated patients? x5

Answer 12

1. Formally assess capacity
2. Make a formal assessment of best interests via checklist required including wether temporary/permanent
3. Check whether there is an advanced directive
4. Check whether there is a proxy-LPA
5. Finally check whether the Court of Protection has appointment a deputy made an order

Question 13

What is meant by liberalism and how is the MCA liberal?

Answer 13

• capacity assumed
• every step taken to prove capacity
• least restrictive option taken
• act in patients best interest
• unwise decisions don’t evidence incapacity