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Best interests decision-making under the Mental Capacity Act

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Best interests decision-making under the Mental Capacity Act

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Page 24
https://autonomy.essex.ac.uk/wp-content/uploads/2016/11/Best-Interests-Green-Paper-v3.0.pdf

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Lack of mental Capacity, under section 3

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Lack of mental Capacity, under section 3

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Capacity is the ability to make your own choices. However, if the individual lacks mental  capacity due to disturbed or impaired ability, they are unable to make an informed decision.

A individual with a impaired or disturbed ability include;

- Mental health conditions, such as bipolar disorder or dementia
- Serve learning difficulties
- Brian damage which are caused through a brain injury or stroke
- Intoxication caused by a large intake of alcohol and drugs
- physical or mental conditions that cause confusion, or loss of consciousness

If a health care professional does not believe the patient  has the full mental capacity to make a clear decision , there decision may  not have relevancy in the final outcome of treatment. If the patient also does not have any one else on their behalf who could enforce a decision, it is within the professionals best interest to make a decision on behalf of their patient based on what is best needed for them at that given moment.

https://www.nhs.uk/conditions/consent-to-treatment/capacity/#

Admission under section 3, allows the patient  to be given the appropriate treatment which is best suited for there needs. A patient will be detained and held within under section 3 when it become a health and safety risk to the patient and other around them.

An application for treatment will only be given when with the consent of two registered medical practitioners. Therefore, medical professionals can enforce appropriate actions to serve the patients best interest whilst under section 3 of the mental health act 1983.

www.legislation.gov.uk/ukpga/1983/20/section/3

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A person’s capacity to understand may be temporarily affected by factors such as confusion, panic, shock, fatigue, pain or medication. However in such circumstances it should not be assumed that they do not have capacity to consent. Where there is any doubt then the healthcare professional should assess the person’s capacity for taking the decision in question. If the assessment is inconclusive, a second opinion should be obtained. Where there is serious disagreement about a person’s capacity to make a particular decision, legal advice should be sought.

http://www.wales.nhs.uk/sitesplus/documents/1064/Welsh%20Government%20Guide%20to%20Consent%20for%20Examination%20or%20Treatment%20%28July%202017%29.pdf

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If the person is being treated under powers for mentally disordered offenders, the test for decision-making ability does not apply.

https://www.mwcscot.org.uk/media/51774/Consent%20to%20Treatment.pdf

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In all care situations, Nurses should demonstrate the following:
- Care
- Compassion
- Competence
- Communication
- Courage
- Commitment

The nurse, working within the multidisciplinary team should work to the best interests of the patient by communicating effectively with both the patient and the team. They should ensure the patient is treated with dignity and compassion.

https://rcni.com/revalidation/6cs-of-nursing-32156

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Inside the Ethics Committee 2010 - Mentally ill and refusing surgery :            https://www.open.edu/openlearn/whats-on/ou-on-the-bbc-inside-the-ethics-committee-2010-mentally-ill-and-refusing-surgery   

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Inside the Ethics Committee 2010 - Mentally ill and refusing surgery :            https://www.open.edu/openlearn/whats-on/ou-on-the-bbc-inside-the-ethics-committee-2010-mentally-ill-and-refusing-surgery   

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Independent Mental Health Advocates (IMHA) 

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Independent Mental Health Advocates (IMHA) 

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If a person is detained under section 3 of the MHA, they have the right to ask for the help of an IMHA. IMHAs are specialist advocates, who can help the patient understand their rights and get their voice heard.

In Wales, a person has the right to an IMHA if he or she:

-is detained under the MHA (exception section 135 or 136)

-is subject to a community treatment order

-is subject to guardianship

-is a conditionally discharged restricted patient

-is in hospital as a voluntary patient

-is being considered for certain treatments

People who use their services can be helped by IMCAs to understand:

their legal rights under the Mental Health Act and the particular parts of the Mental Health Act which apply to them

any conditions or restrictions to which they are subject

any medical treatment that they are receiving or might be given, and the reasons for that treatment

the legal authority for providing that treatment.

Nurses and other mental health professionals have a legal duty to ensure that every person who qualifies is aware of their right to speak to an IMHA.

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Understanding Independent Mental Health Advocacy (IMHA) for mental health staff (SCIE At a glance 67)

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Understanding Independent Mental Health Advocacy for mental health staff is about the role of IMHA, who is eligible, and how to support people who used services to access IMHA.

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The Mental Capacity Act sets out a checklist to consider when deciding what's in a person's best interests.

encourage participation

identify all relevant circumstances

find out the person's views

avoid discrimination – don't make assumptions

assess whether the person might regain capacity – if they might, could the decision be postponed?

https://www.nhs.uk/conditions/social-care-and-support-guide/making-decisions-for-someone-else/mental-capacity-act/

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This is a real life medical case about a mentally ill patient refusing surgery. It focuses on ethical issues.

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This is a real life medical case about a mentally ill patient refusing surgery. It focuses on ethical issues.

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https://www.bbc.co.uk/sounds/play/b00t1xsz

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Factors to take into account when providing beneficence for a patient.

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Factors to take into account when providing beneficence for a patient.

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The extent of the incapacitated person’s ability to participate in the decision

The likelihood that the person will regain capacity in sufficient time to be able to decide personally

The person’s past and present wishes and feelings

His or her beliefs or values where they would be relevant to the decision

The benefits and burdens of the decision
https://www.bma.org.uk/advice/employment/ethics/medical-students-ethics-toolkit/7-consent-to-treatment-lacking-capacity

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Beneficence
When the patient is unable to make an autonomous choice the health professional has a duty of beneficence providing a lasting power of attorney (LPA),  isnt in place. Beneficence is usually considered to rely on an objective view of what would be best for the patient whereas respect for autonomy identifies what the patient subjectively considers to be in his/her best interests. The concept of 'best interests' is linked to well-being / beneficence but includes considerations wider than purely medical risks and benefits such as the religious and cultural interests of the patient. This implies a duty to discover if possible what the patient would have wanted if they were not detained under the Mental Capacity Act.
http://www.ukcen.net/uploads/docs/ethical_issues/consent.pdf

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. Assume the patient has capacity to make this decision.
. Support patient to be able to make an informed and educated decision.
. Just because decision seems unwise to health care professionals - do not make judgements.
. Use best interest checklist if the patient cannot make a decision.
. Use least restrictive options when making the decision on behalf of the patient.

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Inform and educate patient about the benefits of receiving the operation and the effects of not having it, along with the risks.
Allow patient to make an informed decision.
Be non judgemental of their decisions.
Respect patients autonomy.
Just because they are deemed to have lack of capacity in one area of their health, does not mean they lack capacity in this decision and may be well enough to make an informed decision.
Nurses to speak to ward manager and/ or psychologist to determine whether the patient is in a position to be able to make the decision themselves.

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. Nurses must understand individual needs.
. Nurses are responsible for actions taken.
. Nurses must manage risk to keep everyone safe. What could be the result of forcing this patient into having the operation against his will. Will he get violent? will it effect his mental health further?
Need to make sure other patients around are also safe.
. RCN states about involving patients in decision making. This patients views must be listened to and respected.
. Nurses are at the heart of communication and so need to make sure the issues from the patient and the rest of the healthcare team are clear and coherent.

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NMC Code of Conduct.
Respect patients right to autonomy.

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allows for the detention of the service user for treatment in the hospital based on certain criteria and conditions being met.

https://www.rethink.org/living-with-mental-illness/mental-health-laws/mental-health-act-1983/sections-2-3-4-5#s3