1. ADVANCE PLANNING UNDER THE MENTAL CAPACITY ACT Dr Mohan Mudigonda Bilston Health Centre

2. AGENDA What is capacity? How is capacity assessed? Best Interests Relevance for dementia What is advance planning? – Advance Decisions to Refuse Treatment – Advance Statements – Lasting Powers of Attorney

3. WHAT IS CAPACITY ? The ability to reach a particular decision at a particular time Specific, not general Lack of capacity can be temporary or permanent

4. HOW IS CAPACITY ASSESSED? “CURB” Communicate your decision – by any appropriate means: no need for jargon! Understand the information given – Relevant options, procedures etc. Remember the information given – Only for as long as necessary to make the decision Balance the information given – Pros and cons of your decision

5. BEST INTERESTS Becomes relevant when: – Capacity is lost – No Advance Decision is in place Not defined by law; can be interpreted widely but the following must be considered: – Past and present wishes and feelings of the individual – Opinions of carers and loved ones (they do not get the final decision though!) If incapacity is temporary, delay until the individual can decide for themselves if possible i.e. not in an emergency

6. RELEVANCE FOR DEMENTIA Generally, capacity will be stronger in the early stages and gradually decline as the condition progresses Even in the early stages – there may be “good and bad days” Remember – capacity is decision and time specific! It can be planned for!

7. WHAT IS ADVANCE PLANNING? A written/verbal document made to plan ahead for a time when decisions cannot be made Allows you to be in control even when you can’t make a decision yourself Not difficult to make but extremely important to ensure they are valid

8. ADVANCE DECISIONS TO REFUSE TREATMENT Allow for the refusal of medical treatment in particular circumstances – Medications etc. – Life-sustaining treatment e.g. CPR Cannot be used to demand/ request particular treatments If they are “valid and applicable” then they are legally binding and cannot be ignored

9. WHAT MAKES AN ADVANCE DECISION VALID? Must have capacity to make the Advance decision Specify very clearly which treatments are being refused Specify the circumstances of the refusal Can be made verbally but better in writing If treatment is life-sustaining….

10. ADVANCE DECISIONS TO REFUSE LIFE-SUSTAINING TREATMENT (ADRT) E.g. CPR, artificial ventilation Must always be in writing Name, address, contact details Distinguishing features

11. ADRT contd. Signed and dated by the individual and a witness (ideally not related) Must specify that the refusal applies even if the individual’s life is at risk Cannot be used to refuse “basic care” e.g. feeding by mouth as usual, pain relief Artificial feeding e.g. feeding tube, can be refused Do not allow assisted suicide/ anything illegal

12. ADVANCE STATEMENTS Help others to decide what is in your best interests Help you to let people know your wishes and feelings when you cannot express these yourself Can cover any topics which you consider important; diet, religious beliefs, practical issues Anything illegal or against your best interests will not be followed Not legally binding but are very important

13. HINTS AND TIPS Talk to others – GP, carers, family friends Remember though – the final decision is yours Give copies to others and let them know about any changes You can use a specific form but this is not compulsory at all No need for ‘jargon’

14. LASTING POWERS OF ATTORNEY Allow you to choose WHO you want to make decisions on your behalf Choose your attorney carefully – relative, friend or professional – Can appoint more than one and decide how they should make decisions Complete the paperwork (https://www.gov.uk/power-of- attorney/make-lasting-power)https://www.gov.uk/power-of- attorney/make-lasting-power £110 (sorry!)

15. LASTING POWERS OF ATTORNEY contd Register LPA with Office of the Public Guardian Tell those who need to be told No need for a lawyer

16. LASTING POWERS OF ATTORNEY contd 2 types – Personal Welfare e.g. daily routine, medical care, life sustaining treatment – Property and financial affairs e.g. managing money, paying bills, selling home Your attorney must always act in your best interests

17. Many thanks for listening! Dr Mohan Mudigonda: m.mudigonda@nhs.net