Independent Mental DATE: Capacity Advocacy 25/02/2020 DNACPR INFORMATION - for Health Care For Health Care professionals Professionals
Content DATE: • Types of decision where an IMCA may be involved 25/02/2020 • What constitutes Serious Medical Treatment ? DNACPR • Documenting the decision and the capacity assessment INFORMATION - for Health • Who is the assessor/decision maker? Care Professionals • Who is appropriate to consult for SMT decisions? • Case Law • Making an IMCA Referral
Mental Capacity Act 2005 DATE: 25/02/2020 DNACPR INFORMATION What you need to know about involving an - for Health Care Independent Mental Capacity Advocate (IMCA) in Professionals Best Interest decision making
Types of decision when an IMCA may be involved; DATE: When a person is assessed as lacking mental capacity, and there is no one 25/02/2020 else appropriate to consult with, there is a legal duty to instruct an IMCA for the following decisions; DNACPR INFORMATION - for Health 1) Serious Medical Treatment Care Professionals 2) Change of Accommodation And IMCA may be instructed for the following decisions; 1) Adult safeguarding 2) Care Review
DATE: 25/02/2020 DNACPR INFORMATION Serious Medical Treatment decisions - for Health Care Professionals
MCA 10.45 - SMT is defined as DATE: treatment which involves giving 25/02/2020 new treatment, stopping DNACPR INFORMATION treatment or withholding - for Health treatment that could be offered Care Professionals where … what is proposed is likely to have serious consequences for P.
The Mental Capacity Act code of practice defines an SMT decision as the following; DATE: Serious medical treatment is defined as treatment which involves; 25/02/2020 • giving new treatment, stopping treatment that has already started or withholding treatment that could be offered in circumstances where: DNACPR • if a single treatment is proposed there is a fine balance between the likely benefits and the INFORMATION burdens to the patient and the risks involved - for Health • a decision between a choice of treatments is finely balanced, or Care Professionals • what is proposed is likely to have serious consequences for the patient. ‘Serious consequences’ are those which could have a serious impact on the patient, either from the effects of the treatment itself or its wider implications. This may include treatments which: • cause serious and prolonged pain, distress or side effects • have potentially major consequences for the patient (for example, stopping life -sustaining treatment or having major surgery such as heart surgery), or • have a serious impact on the patient’s future life choices (for example, interventions for ovarian cancer).
Examples of SMT decisions; • chemotherapy and surgery for cancer DATE: • electro -convulsive therapy 25/02/2020 • therapeutic sterilisation • major surgery (such as open -heart surgery or brain/neuro-surgery) DNACPR INFORMATION • major amputations (for example, loss of an arm or leg) - for Health • treatments which will result in permanent loss of hearing or sight Care • withholding or stopping artificial nutrition and hydration, and Professionals • termination of pregnancy. • DNACPR and end of life planning • treatment involving General Anaesthetic • the proposed treatment could have serious consequences for the client
Documenting the Best Interest Decision Document the capacity assessment The 2 stage test DATE: 25/02/2020 The functional test • Is there an impairment of or DNACPR The person is unable to make a decision disturbance in the functioning of the INFORMATION if they cannot: person’s mind or brain? - for Health • Is the impairment or disturbance Care Professionals 1. Understand information about the sufficient that the person lacks the decision to be made capacity to make that particular 2. Retain that information in their mind decision? 3. Use or weigh-up the information as part of the decision process 4. Communicate their decision
Document the Best Interest Decision DATE: 25/02/2020 • How was the Best Interests decision reached? DNACPR INFORMATION • What factors were taken into account? - for Health Care Professionals • What other treatment options were considered in reaching the decision? • Who was consulted?
The assessor/decision maker DATE: • The GP/Doctor is the decision 25/02/2020 “If a doctor or healthcare professional maker when considering an SMT proposes treatment or an / DNACPR DNACPR examination, they must assess the INFORMATION person’s capacity to - for Health consent…..ultimately it is up to the Care • The GP/Doctor needs to assess Professionals professional responsible for the the person’s capacity to be person’s treatment to make sure that involved in this decision (Mental capacity has been assessed.” Capacity Act Codes of Practice S.4.40 / S4.42):
Consultation DATE: 25/02/2020 DNACPR 10.42 MCA code of practice . – Where SMT is being considered INFORMATION for a person who lacks capacity to consent and there is no-one - for Health appropriate to consult NHS bodies must instruct an IMCA Care Professionals (S.37MCA)
When there is a duty to instruct an IMCA DATE: • When a person has been assessed as lacking capacity regarding the proposed 25/02/2020 serious medical treatment decision. If there is no one else appropriate to consult with regarding the best interest decision, the decision maker has a legal duty to DNACPR instruct an IMCA. INFORMATION - for Health Care • A disagreement between professionals and the appropriate person is not reason Professionals to deem them not appropriate to consult with. • However, an IMCA can be instructed if there are concerns that the family/friend may not be acting in the person’s best interest.
If a person lacks capacity to consent – who is appropriate to consult ? DATE: 25/02/2020 • Are there appropriate friends, family or unpaid carers to discuss the SMT/DNACPR DNACPR INFORMATION decision with ? - for Health • Care An appropriate person must be someone not acting in a paid capacity; it cannot be Professionals another paid professional. An appropriate person could be a friend or family member of the client. ( S.10 – Code of Practice 2005 ) • Is there an LPA for health and welfare decisions? If yes the person/s with LPA must be consulted • If there is no LPA – friends and family can still be consulted if they are appropriate • No appropriate person to consult? An IMCA must be consulted (S.10.8 MCA)
When an IMCA is not required ; DATE: • The client has mental capacity regarding the SMT decision 25/02/2020 DNACPR • There is someone who is appropriate to be consulted for the decision INFORMATION - for Health Care Professionals • An urgent decision is required to provide life sustaining treatment • The medical treatment would not be considered ‘serious medical treatment’ as described in the Mental Capacity Act code of practice.
Urgent Decis isio ions DATE: 25/02/2020 Guidance from the British Medical Urgent decisions will have to be Association, the Resuscitation Council made and immediate action taken DNACPR INFORMATION (UK) and the Royal College of Nursing in someone’s best interests in these …. “If a CPR decision is needed when - for Health situations. It may not be practical or Care an IMCA is not available, the decision appropriate to delay treatment or Professionals should be made, the reasons for it to consult the person or known should be documented in the health attorney’s, IMCAs (S 3.6 MCA Code record and an IMCA should be of Practice) consulted at the first available opportunity.”
What is the Role of the IMCA? • To meet with the person and represent their views and wishes throughout the decision DATE: making process. 25/02/2020 • The ensure that the Mental Capacity Act principles are complied with, and raise concerns where necessary. DNACPR • To consult with the decision maker about the treatment options and ask questions, raise INFORMATION issues and offer information on the person’s behalf - for Health • To ask for a second medical opinion if required- this could be regarding mental capacity Care or treatment options. Professionals • To consult with all relevant people to gather information relevant to the decision. This could include persons past views or wishes, spiritual or cultural beliefs and what course of action the client may have wanted when they had mental capacity. • To attend best interest meetings as required. • To produce a written report which is shared with the decision maker. • To recommend an application to the Court Of Protection for complex decisions which are so finely balanced that a decision cannot be reached, or if there is dispute.
DATE: • “ Is to support an represent the person who lacks capacity…..IMCA’s have the 25/02/2020 right to see relevant health care and social care records .” DNACPR • This would include the right to see the mental capacity assessment. INFORMATION - for Health Care • “Any information or reports provided by the IMCA must be taken into account Professionals as part of the process of working out whether a proposed decision is in the person’s best interests.” (Mental Capacity Act of Codes of Practice – Chapter 10)
DATE: 25/02/2020 Case Law DNACPR relating to consultation for INFORMATION - for Health DNACPR decisions Care Professionals
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