These Regulations define "NHS body" and "serious medical treatment" for the purposes of certain provisions the Mental Capacity Act 2005 ("the Act") which deal with independent mental capacity advocates ("IMCAs"). The Regulations also contain provision as to who can be appointed to act as an IMCA and as to an IMCA's functions when he has been instructed to represent a person in a particular case. The provisions about the IMCA's appointment and functions apply where the IMCA is instructed under sections 37 to 39 of the Act or under regulations made by virtue of section 41 of the Act (see regulation 2(2)).
The following guidance is for PCTs, local authorities, hospitals and care homes to support them understand and fulfill their statutory obligations under the Mental Capacity Act Deprivation of Liberty Safeguards legislation.
The aim of this guideline is to inform health and social care professionals on how best to manage advance care planning (ACP) in clinical practice. At the core of current health and social care are efforts to maximise individuals’ autonomy, promote patient-centred care, offer choice and the right to decide one’s own treatment or care. This can be difficult to achieve when an individual has lost capacity – the ability to make their own, informed decision. ACP is one method of enhancing autonomy, not only where an individual has lost capacity, but also by focussing discussion on the individual’s values and preferences throughout the time they are in contact with health or social care professionals. Whilst ACP has been used for some time in North America, there has been relatively little experience in the use of ACP in the UK. This set of concise evidence-based guidelines has therefore been prepared to guide practitioners.
This site explains how the law now allows people to make decisions to refuse treatments including those that sustain life. Many people want to achieve a natural and dignified death, this is one way to help achieve it. This is a free and non-profit NHS website. We suggest people enter the site using the relevent menu section (above). Many people benefit from looking at both sections.
The issue in this case is not uncommon. P is an adult who has an unresolved medical condition, in this case epilepsy. His primary carer, however well motivated, does not accept the diagnosis nor the treatment proposals. P may object to treatment (whether his own view or prompted by his carer). In order to determine what is in P's best interests, since he cannot decide for himself, it is necessary to observe him, and not to rely upon what is relayed about his condition by his carer. To that end, a period in hospital for assessment and treatment is necessary.
A fundamental aspect of the Mental Capacity Act 2005 (MCA) is the statutory endorsement of a functional approach to capacity. In principle, this requires a separate assessment of capacity in respect of each decision to be made. Most capacity assessments take place at a non-judicial level, and, outside of day-to-day decisions, the most common assessors are likely to be healthcare professionals. This paper investigates the practical operation of the capacity assessment process at both judicial and non-judicial levels. It asks whether the process can deliver on the MCA's goal of preserving maximum decision-making freedom, while, at the same time, providing an appropriate degree of protection. It argues that assessors who are not legally trained encounter signific
More than 700,000 people in the UK currently suffer from dementia, and nearly 500,000 friends and family members act as carers for people with dementia. Our rapidly ageing population means that these numbers are likely to double in the next forty years. While we are getting to understand better the causes of the disease, and diagnostic and treatment options are improving, we are still a long way from prevention or cure. Meanwhile, these people and their families, healthcare staff and care workers face difficult ethical dilemmas on a day-to-day basis. An exploratory workshop was held in March 2007, and the Nuffield Council set up a Working Party in December 2007 to examine the ethical issues raised by dementia. Following a public consultation and meetings with stakeholders including people with dementia, carers, health professionals and other members of the public, a report with recommendations for policy makers was published on 1st October 2009.
Whether treatment decision-making capacity can be meaningfully applied to patients with a diagnosis of "personality disorder" is examined. Patients presenting to a psychiatric emergency clinic with threats of self-harm are considered, two having been assessed and reviewed in detail. It was found that capacity can be meaningfully assessed in such patients, although the process is more complex than in patients with diagnoses of a more conventional kind. The process of assessing capacity in such patients is very time-consuming and may become, in itself, a therapeutic intervention.
Doctors will be allowed forcibly to sedate the 55-year-old woman in her home and take her to hospital for surgery. She could be forced to remain on a ward afterwards. The case has sparked an intense ethical and legal debate. Experts questioned whether lawyers and doctors should be able to override the wishes of patients and whether force was ever justified in providing medical care.
A cancer patient who has a phobia of hospitals should be forced to undergo a life-saving operation if necessary, a High Court judge has ruled. Sir Nicholas Wall, sitting at the Court of Protection, ruled doctors could forcibly sedate the 55-year-old woman - referred to as PS. PS lacked the capacity to make decisions about her health, he said. Doctors at her NHS Foundation trust had argued PS would die if her ovaries and fallopian tubes were not removed. Evidence presented to Sir Nicholas, head of the High Court Family Division, said PS was diagnosed with uterine cancer last year.
The 30-year-old, known only as SB, could die without emergency treatment for aplastic anemia, a condition in which her bone marrow does not reproduce enough new blood cells. The Court of Protection has now ruled that doctors can restrain SB and force her to undergo the arduous but potentially life-saving treatment, which is administered through a vein in the heart and lasts for five days. SB has been detained under the Mental Health Act. Family Division judge Mrs Justice Hogg ruled that the patient did not have the capacity to make up her own mind over whether to undergo the treatment.
A high court judge in England has ordered that doctors can force a woman without the capacity to decide for herself to have lifesaving treatment for aplastic anaemia. Mrs Justice Hogg made the ruling in the Court of Protection after an unnamed NHS trust applied to the court with the backing of the Official Solicitor, who looks after the interests of those lacking capacity. The judge said the 30 year old woman, named only as SB, who is detained under the Mental Health Act, has a serious psychiatric disorder and lacks the capacity to decide for herself whether or not to have the potentially lifesaving treatment.
More than 11,000 people were deprived of their liberty last year using controversial new legislation that critics have argued is “not fit for purpose”. New figures released by the Department of Health reveal how local authorities and hospitals are increasingly relying on so-called Deprivation of Liberty Safeguard (DoLS) orders to detain people for their own safety.
A lady has cancer of the uterus. She could be cured by a potentially life-saving operation. However, because of other co-morbidities and other factors there is a considerable risk that she could die during the operation or in the post-operative recovery period. She herself lacks the capacity to make an informed decision, but she denies that she has cancer at all and opposes and is resistant to the operation. The medical team at the hospital consider that she would benefit from the operation and would like to perform it. The lady's three adult sons all strongly desire that she should have the operation and feel that the potential benefit outweighs the risk. The Official Solicitor, who acts as her litigation friend, considers, in a phrase, that it is too risky. The question for the court is whether, balancing all the relevant factors, it is in her overall best interests to have the operation or not.
The man’s lawyer stressed the case was not covered by the shadow of eugenics The Court of Protection could make legal history this month if it sanctions the sterilisation of a man with learning difficulties who lacks the ability to give permission.
25th July 2013: The Mental Capacity Act (MCA) made Advance Decisions to refuse treatment legally binding in statutory law in 2005, and Compassion in Dying has been providing free information on end of life and Advance Decision forms since 2010. A new study, which looked at in excess of 200 calls to Compassion in Dying, found that a major barrier to patients exercising choice was doctors’ failure to engage with patients about their Advance Decision and the lack of systems in place to record them. Two callers reported considering a ‘DNR tattoo’ as a way of addressing this problem. The study also found women (84% of callers) are more likely than men (16%) to make their wishes known at the end of life. Professor Sue Wilkinson, author of the report and Professor of Feminist and Health Studies in the Department of Social Sciences at Loughborough University said: “This study has led to a number of recommendations for Compassion in Dying, and more broadly for the integration of Adva...
This is an application made by the NHS Foundation Trust in the Court of Protection for a raft of declarations in relation to a young man, M, who was born on 19th June 1990 and so approaches his 23rd birthday. M was tragically born with a congenital abnormality of the brain called holoprosencephaly ("HPE"). It is common ground that in the period of time since 2010 M's condition has significantly deteriorated. He is now seriously malnourished and, in the view of both the treating physicians and independent experts instructed for the purposes of this hearing, reaching the end of his life. The painful and difficult issues now to be faced by M's family, the medical team that have cared for him so diligently over many years, and ultimately this court, is to what extent should M be treated in Intensive Care or be given cardio-pulmonary resuscitation ("CPR") in the event that there is a further deterioration in his condition. There is no question of M having the capacity himself to make...
Judge approves forced Caesarean for mentally-ill woman Doctors have been granted permission to perform an urgent Caesarean section on a mentally-ill woman with diabetes. High Court judge Mr Justice Hayden gave specialists at the Royal Free London NHS Trust approval after a five-hour hearing at the Court of Protection. He said the decision was "draconian" but necessary because the mother's life may be in danger. The woman, 32, who is 32 weeks pregnant, was deemed unable to make the decision over how to give birth. The ruling, late on Friday, came after doctors applied for permission to carry out the delivery in order that the patient's "unstable mental state" could be treated. A specialist from the trust told the Court of Protection in London, which specialises in issues relating to the sick and vulnerable, that their priority was "keeping this woman alive".
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