Mental Capacity Act (2005) Flashcards
What are the principles of the Mental Capacity Act (MCA)?
A person must be ASSUMED to have capacity until established that they lack capacity
A person is not to be treated as unable to make a decision until all practicable steps to help them to do so have been taken without success (ENABLED)
A person is not to be treated as unable to make a decision because they make an UNWISE decision
An act done or decision made under this act for or on behalf of a person who lacks capacity must be in their BEST INTERESTS
Before decisions are made, regard to whether the purpose of the decision can be effectively achieved in the LEAST RESTRICTIVE way possible
Who is deemed to lack capacity?
2 stage test:
1 - does the person have an impairment of, or a disturbance in the functioning of, their mind or brain?
2- does the impairment/disturbance mean the person is unable to make a specific decision when they need to?
It does not matter if the impairment/disturbance is permanent or temporary
Not simply due to: a persons age, appearance, condition, aspect of behaviour which might lead others to make unjustified assumptions about their capacity
What is necessary for a person to make a decision?
To understand the relevant information - if they have it explained to them in simple language/using any other appropriate visual aids etc
To retain the information - even if only for a period of time in which the decision needs to be made
To use/weigh that information as part of a decision making process
To communicate the decision made (verbal or non verbal)
What is necessary to consider when making decisions in someones best interests?
Whether the individual is likely to regain capacity to make the relevant decision and when that will most likely be
Must encourage\involve individual in decision making process as best as they can using all available means
Must consider past/present wishes/feelings/beliefs/values/other relevant factors - obtained from advance statements/named individual to be consulted under these circumstances/carers/LPA/court appointed deputy
What does the act say about life sustaining treatment and best interests?
As with all best interests, opinions/wishes of patient and family are taken into account
No ethical/legal duty to continue life-sustaining treatment where it is excessively burdensome relative to the likely benefits - can thus be deemed not in the individuals best interests
Competent patients have the power to refuse life sustaining treatment but not demand it - the final decision rests with the clinical team
Decision maker must not be motivated by a desire to bring about the individual’s death
What is a Lasting Power of Attorney (LPA)?
The donor gives the authority to the donee to make decisions about:
The doners personal welfare and/or properties and affairs or specified matters related to their welfare/affairs
Donee must be 18 and have capacity; can be multiple donees each given different responsibilities
Can be used only when the donor does not have capacity; used to prevent harm to the donor; does not work for life sustaining treatment (giving/refusing) unless the instrument contains express provision to that effect
What role does the court have in patient’s without capacity?
Can make orders on welfare/affairs or appoint a deputy to do so on individual’s behalf - need to act on best interests
Decisions can be made on - deciding where individual is to live, who they have contact with, consenting/refusing treatment, property controls etc
Whats the relationship between the MHA and the MCA?
MCA does not authorise anyone to give a patient treatment for mental disorder or consent to a patient being given treatment for mental disorder if at the time the decision is required, the individuals treatment is regulated by part 4 of the MHA
What powers does the MCA grant doctors in medical care?
Allows doctors to treat (including restraint and restrictions) a patient who is deemed not to have capacity, providing they are in the patients best interests
What is DoLS?
Deprivation of Liberty Safeguards
Safeguards - come into play when the treatment requires restrictions and restraint that will deprive the patient of their liberty
Only in a care home or hospital setting - organisation must put in a request to do so; 6 assessments need to be undertaken before permission granted and has to be reviewed by Dr/social worker
Comes into play when capacity restricted for more than 7 days (under 7 = use normal act)
When putting together a careplan for someone without capacity - need to be aware of any possible restrictions placed and if so, apply for DoLS
Urgent authorisation lasts 21 days; after proper assessment and approval lasts for 12m (and length of time must be stated) - cannot be extended, must reapply
What are the key components to advanced decisions/directives?
Allow the person to specify (before they have lost the capacity to decide) what treatments they would not want and would not consent to (for example mechanical ventilation or cardiopulmonary resuscitation)
Cannot demand treatments
Must be respected and sought out (if not obviously present) by clinicians
Can be withdrawn if the person retains (or regains) capacity
Can be made verbally, except for decisions that refuse life-sustaining treatment (such as artificial ventilation), which must be written, signed, and witnessed
Cannot refuse basic care, such as the provision of warmth, shelter, hygiene, food, and water. However, clinically assisted nutrition and hydration (that is given intravenously, subcutaneously, or via a gastrostomy), which are considered in law to be medical treatments, can be refused
When is an advanced decision to refuse treatment binding?
The person making the advance decision was at least EIGHTEEN years of age, and had the necessary mental capacity
It SPECIFIES TREATMENT to be REFUSED, and the applicable CIRCUMSTANCES
It has NOT been WITHDRAWN
Nobody has subsequently been given power of attorney to make treatment decisions on the person’s behalf - NO LPA
The person making the advance decision has not subsequently given reason to believe that they have changed their mind - SURE
What is the ‘Acid test’ to see if someone is being deprived of their liberties?
- is the person subject to continuous supervision and control? AND
- is the person free to leave? (in terms of how others would/would not support them to leave should they wish)
How long does a supervisory body have to decide whether someone is to be deprived of their liberties?
Within 21 days
What conditions does the supervisory body use to decide whether someone can be deprived of their liberties?
Must all be met (if not, then hospital/care home has to change plans so the person can be supported in a less restrictive way):
The person is EIGHTEEN or over (different safeguards apply for children)
The person is suffering from a MENTAL DISORDER
The person LACKS CAPACITY to decide for themselves about the restrictions which are proposed so they can receive the necessary care and treatment
The restrictions would DEPRIVE PERSON OF LIBERTY
The proposed restrictions would be in the person’s BEST INTERESTS
Whether the person should instead be considered for detention under the Mental Health Act
There is NO VALID ADVANCE DECISION TO REFUSE treatment or support that would be overridden by any DoLS process
