Mental capacity act Flashcards
(41 cards)
What is the mental capacity act for
It provides a statutory framework for people who lack capacity to make decisions for themselves, or who have capacity and want to make preparations for a time when they may lack capacity in the future.
What are the 5 principles of the MCA
(For capacity):
- Presume Capacity
- Practicable support
- Unwise decisions
(Lack capacity):
4. Best interests
5. Less
restrictive
When would you be called to understand if someone lacks capacity
The Act’s starting point is to confirm in legislation that it should be assumed that an adult (aged 16 or over) has full legal capacity to make decisions for themselves, UNLESS it can be shown that they lack capacity to make a decision for themselves.
The person’s behaviour or circumstances raise doubt as to whether they have the capacity to make a decision
Concerns about a person’s capacity have been raised by someone else; for example, a family member or a healthcare worker.
Can an individual with capacity refuse medication? What if the treatment is in their best interests?
Absolute right to refuse medical treatment even if the proposed treatment is clearly in their best interests (ensure patient has had all information required for informed CHOICE)
Who can consent on behalf of a competent adult
No one can consent on behalf of a competent adult
T/F an unwise decision by a competent adult can be overturned by a doctor
F… a competent adult has the right to make unwise decisions
How is decision making capacity maximised
INFORMED consent
What must a person have to give valid consent or permission
Information about the decision
Free choice to make the decision without being unreasonably pressured or forced
The Mental Capacity to be able to consent or refuse
What must we explain to help someone decide whether or not to consent
why the care or treatment is needed
the options available and what they entail.
what is likely to happen if the person does consent (Risks associated)
what is likely to happen if the person refuses the care or treatment
What is the 2 stage test of capacity
Does the person have an impairment, or a disturbance in the functioning, of their mind or brain?
Is the impairment or disturbance sufficient to impair capacity to make a decision?
Give some examples of impairment/disturbance in functioning mind/brain
Cognitive impairment Dementia Delirium – acute confusional state Some mental health conditions Drug/alcohol intoxication (or withdrawal!)
What must a person be able to do to make a decision
- Understand
- Retain
- Weigh up and balance
- Communicate back
What is meant by understand the decision
Understand the decision to be made and the information provided about the decision. The consequences of making a decision must be included in the information given.
What is meant by retain infromation
Retain the information – a person should be able to retain the information given for long enough to make the decision. If information can only be retained for short periods of time, it should not automatically be assumed that the person lacks capacity. Notebooks, for example, could be used to record information which may help a person to retain it.
treating)
What is meant by weigh up and balance
Weigh up and balance Use that information in making the decision – a person should be able to weigh up the pros and cons of making the decision. (eg risks of treating vs risk of not
What is meant by comminicate decision
Communicate their decision – if a person cannot communicate their decision – for example, if they are in a coma – the Act specifies that they should be treated as if they lack capacity. You should make all efforts to help the person communicate their decision before deciding they cannot.
What is fluctuant capacity
Capacity can be partial, temporary and change over time
Is the person likely to regain capacity, and if so can the decision wait until they have capacity?
……
What condition must be met to protect you from liability if an action is used to restrain somebody
The person taking action must reasonably believe that restraint is necessary to prevent harm to the person who lacks capacity, and
The amount or type of restraint used and the amount of time it lasts must be a proportionate response to the likelihood and seriousness of harm
What does best interests mean
Unless there is a valid and applicable Advanced Directive then decisions made on behalf of a person lacking capacity must be in the person’s best interests, whoever is making the decision
Carers
Healthcare professional
Court
Court appointed Deputy
What is an independent mental capacity advocate.
The IMCA is an advocate NOT the decision maker
What does the IMCA do
be independent of the person
represent the person to work out whether the proposed is in the person’s best interests
provide information to help identify the person’s best interests
challenge decisions which appear not to be in best interests
T/F IMCAs are not allowed access to healthcare records
F.
IMCAs have the right to see relevant healthcare and social care records
When must an IMCA be instructed
An IMCA must be instructed for people lacking capacity who have no-one else to support them when:
- Making decisions about serious medical treatment
- When proposing/changing accommodation in hospital or a care home, and:
the person will stay in hospital > 28 days OR
they will stay in the care home > 8 weeks
