Ethical issues in mental health

Question 1

What are the 2C2R elements to capacity?

Answer 1

A person is unable to make a decision for himself if he is unable to do all or any one of the following:
C - comprehend the information provided to them in order to make the decision.
R - remember that information; for long enough to make the decision
R - reason with that information during the process
of making the decision; or
C - communicate the decision made (whether by talking, using sign language or any other means)

Question 2

What are the 5 Principles in Mental capacity Act?

Answer 2

• A person must be assumed to have capacity unless it is established that he/she lacks capacity
• A person is not treated as unable to make a decision unless all practicable steps to help him/her to do so have been without success
• A person is not to be treated as being unable to make a decision merely because he/she makes an unwise decision
• An act done or a decision made, under this Act for
  or on behalf of a person who lacks capacity must be
  done, or made, in his best interests
• Before the act is done, or the decision is made, regard must be had to whether the purpose for which it is needed can be effectively achieved in a
  way that is less restrictive of the person’s rights and
  freedom of action

Question 3

What is the mental health (care and treatment) act and its purpose? + 5T&C

Answer 3

A designated medical practitioner can involuntarily
admit a patient without consent for treatment for up
to 72 hours.

allows for the detention of a person at a psychiatric institution for treatment if:
* he/her is suffering from a mental disorder – detention is warranted
* necessary in the interests of the health or safety - person or for protection others

T&C:
* only medical practitioners that have been designated
by name or office in writing by the Director of Medical
Services may sign an order for admission and detention
* penalties for improper reception or detention of
mentally disordered persons
* a Magistrate’s order is required if the period of
detention exceeds 6 months
* mentally disordered persons may only be detained in
psychiatric institutions designated by the Minister for Health (psychiatric wards can be designated as psychiatric institutions)
* the psychiatric institution is to be inspected regularly by visitors appointed by the Minister for Health

Question 4

What can donee LPA do?

Answer 4

i. personal welfare
and/or
ii. property and affairs

BUT not those related to
life-sustaining treatment and those which a person providing healthcare reasonably believes is necessary to prevent a
serious deterioration in the donor’s condition

Question 5

What is the difference between the LPA and Will?

Answer 5

The LPA takes effect only when the donor loses his/her mental capacity, and it loses its effect on death
A Will is to provide for the administration and distribution of what he owns (‘his estate’) among his beneficiaries after this death

Question 6

What are the ethical issues in relation to the LPA? (3)

Answer 6

Patient’s Autonomy
Beneficence
Non-maleficence

Question 7

Can there be more than one donee?

Answer 7

Yes