Describe importance of human rights act and mental capacity act
- Safety net
- Protects freedom of everyone in society, especially people in vulnerable situations (eg. mental capacity problems)
- Mental capacity act 2005 empowers people to make their own decisions, and allows others to make decisions in their best interests when they are unable to do so. Supported by code of practice.
Describe the 5 statutory principles of the mental capacity act
- Presume capacity in adults unless it can be shown they do not
- Support to make the decision
- People have the right to make unwise decisions (eg. refuse medical treatment even if clearly in their best interest)
- Act in patients best interests if they do not have capacity
- Less restrictive - If you can achieve the same result by an option that interferes less with the person’s freedom then you should choose that option
Why may capacity be questioned?
- Behaviour or circumstances raise doubt
- Concerns have been raised by someone close to the person (family member or health care worker)
Describe what is given to patients to make informed consent
- Why care is needed
- Options and what they entail
- What is likely to happen if person does or does not consent
Describe 2 step determination of capacity
- Does the person have an impairment or disturbance in functioning of their mind or brain?
- Is the impairment or disturbance sufficient to impair capacity to make a decision
List examples of impairment of structure or function
- Head injuries
- Learning difficulties
- Delerium (acute confusional state)
List 4 things required to make a decision
- Weigh up and balance
- Communicate back - make all efforts to help the person communicate before deciding you are unable
What is fluctuant capacity
- Capacity can be partial, temporary and change over time
- Can the decision wait until they have capacity
How is restraint determined?
Action to restrain someone who lacks capacity must meet these criteria:
- Amount or type of restraint must be proportionate to the likelihood and seriousness of harm
- Prevent harm to the person who lacks capacity
What is a independent mental capcaity advicate?
- Advocate not decision maker
- Represent the person to help identify their best interests, and work out whether proposed is in their best interests.
- Challenge decisions which don’t appear to be in the patients best interests
- Have the right to see relevant healthcare and social care records
WHen is a IMCA used?
- Used when adults lack capacity and have no one to support them making decisions about serious medical treatment
- When proposing accommodation in hospital or a care home (hospital over 28 days and care home 8 weeks)
- Only exception is urgent decisions
Describe role of a IMCA
- Visit in care home hospital or elsewhere
- Collect relevant info
- Consult health professionals, friends and neighbours
- Support the patients to make decisions for themselves
- Help the patient make a complaint
What is an advance decision?
- People above age of 18 may make advance decision under MCA 2005
- This is only for advance refusal when the person lacks mental capacity
- Must be specific about the treatment refused and circumstances where the refusal applies
- Person must have been competent and understood the decision
- Refusal of life prolonging treatment must be in writing and witnessed
- Legally binding if patient an adult, competent and properly informed, applicable to situation and no reason to believe they changed their mind
- Considered but not legally binding if not for the exact same decision
- Cannot refuse treatment under mental health act or basic nursing care
What is basic nursing care?
- Cleaning, washing, changing, dressing wounds
- Oral food and fluid
How are HCPs protected with advance directives?
- HCPs protected if they are unaware and have tried to identify the advance directive.
- Or if the advance decision is no longer applicable or valid
- If followed, reasonable effort should be made to prove it is valid and applicable
What is an advanced statement?
- Explains your likes and dislikes and anything important for you to be comfortable
- Taken into consideration but not legally binding
What is lasting power of attorney?
A power of attorney is a legal document that allows another person authority to make a decision on another’s behalf
- Donee can make decisions valid as one made by donor
- Must be over 18 and have capacity (welfare and property + affairs)
- If the person has capacity, welfare LPA cannot be used
- Donor (person who eventually lacks capacity) can specify limits
- Must be written and signed
What are deprivation of liberty safeguards?
- Now called liberty protection safeguards
- Protection for vulnerable people who are in hospitals or care homes in circumstances that amount to deprivation of their liberty, who lack capacity to consent to the care or treatment they need
- As of 2020 has extended to people living at home (eg. elderly relatives)
- Not used if patients are sectioned in psychiatric units or under community care orders. Medication can be given covertly
- Deprivation of liberty should be avoided where possible, and only authorised where it is in the relevant persons best interests and the only way to keep them safe. Should be only for a particular treatment plan, and as short a time as possible
For deprivation of liberty it needs to be clear that…
- Person lacks capacity to consent
- Person has a mental disorder
- Arrangements necessary to prevent harm to the cared for person and proportionate to the likelihood and seriousness
Describe acid test
- An individual who lacks capacity to consent and is subject to continuous supervision and control and are not free to leave
- This is a deprivation of liberty
- Should be able to have a DOLS application