5 Principles of the Mental Capacity Act (MCA) 2005 –Assume Capacity –Help people have capacity in all practical ways before deciding they don’t have capacity –People are entitled to make unwise decisions –Decisions for people without capacity should be in their Best Interests –Decisions for people without capacity should be the least restrictive possible
(1) Presumption of Capacity Every adult has the right to make his/her own decisions and must be assumed to have capacity to do so unless proven otherwise This means you cannot assume that someone cannot make a decision for themselves just because they have a particular medical condition or disability
(2) Individuals being supported to make their own decisions A person must be given all possible help before anyone treats them as not being able to make their own decisions This means you should make every effort to encourage and support people to make the decision for themselves If lack of capacity is established it is still important that you involve the person as far as possible in making decisions.
(3) Unwise Decisions People have the right to make decisions that others might regard as unwise or eccentric You cannot treat someone as lacking in capacity for this reason Everyone has their own values, beliefs and preferences which may not be the same as those of other people.
(4) Best interests Anything done for or on behalf of a person who lacks mental capacity must be done in their best interests person Person who has to make the decision is known as the decision-maker ad normally will be the carer responsible for day to day care or professional such as doctor, nurse, social worker where decisions about treatment, care and arrangements or accommodation need to be made.
(5) Less Restrictive Option Someone making a decision acting on behalf of a person who lacks capacity must consider whether it is possible to decide or act in a way that would interfere less with the person’s rights and freedoms of action, or whether there is a need to decide to act at all. Any intervention should be weighed up in the particular circumstances of the case.
What do we do if worried about capacity?
Assessing capacity Should be assessed by (a) anyone caring for patient, (b)health/social care and/or (c) if complex- GP/psychiatrist 2 stage assessment ; 1. Is there disturbance/impaired function of mind/brain? 2. does this cause a lack of capacity to make decision?
Assessing capacity (CURB) Communication- best setting/environment? Hearing aid? Understand information given to them? Retain the information long enough to be able to make the decision? Balance/weigh up the information available to make the decision? (risk/benefits) and communicate their decision without coercion
Lacking Capacity? Best interest Before best interest does patient have; IMCA Advance decision Personal welfare lasting power of attorney Court appointed deputy Best interest meeting Treat as individual
Considerations in best interest All relevant circumstances related to any decision Fluctuating capacity? Likely to regain capacity? Can it wait until they regain capacity? Patients wishes and feelings? Whether expressed or written Beliefs and values including cultural and religious
Were you paying attention? 1)First row, two from left – what is the 1 st principle of the Mental Capacity Act? A: Presumption of capacity 2) Back row, 1 st of right – what is the most important of the principles to you and why? A: no wrong answer 3) Middle row, middle person – what test as GPs can we use to test capacity? A: CURB