Mental Capacity Act Tool Kit_card9
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24 British Medical Association Mental Capacity Act tool kit • Advance decisions refusing treatment CARD 9 ADVANCE DECISIONS REFUSING TREATMENT 1 What is an advance decision? The Act makes it clear that somebody who is aged 18 or over and has the necessary mental capacity can refuse specified medical treatment for a time in the future when he or she may lose the capacity to make the decision. This is known as an advance decision. The Act’s powers are restricted explicitly to advance decisions to refuse treatment. An advance refusal of treatment is binding if: • the person making the decision was 18 or older when it was made, and had the necessary mental capacity • it specifies, in lay terms if necessary, the specific treatment to be refused and the particular circumstances in which the refusal is to apply • the person making the decision has not withdrawn the decision at a time when he or she had the capacity to do so • the person making the decision has not appointed, after the decision was made, an attorney to make the specified decision • the person making the decision has not done anything clearly inconsistent with the decision remaining a fixed decision. 2 Can advance decisions extend to refusing life-sustaining treatment? Although advance decisions can be oral or in writing, an advance refusal will only apply to
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MCA toolkit for psychiatrists and mental health professionals
Transcript of Mental Capacity Act Tool Kit_card9
24 British Medical Association
Mental Capacity Act tool kit •Advance decisions refusing treatment
CARD 9
ADVANCE DECISIONS REFUSINGTREATMENT
1 What is an advance decision?The Act makes it clear that somebody who isaged 18 or over and has the necessary mentalcapacity can refuse specified medicaltreatment for a time in the future when he orshe may lose the capacity to make thedecision. This is known as an advance decision.The Act’s powers are restricted explicitly toadvance decisions to refuse treatment. Anadvance refusal of treatment is binding if:• the person making the decision was 18 or
older when it was made, and had thenecessary mental capacity
• it specifies, in lay terms if necessary, thespecific treatment to be refused and theparticular circumstances in which the refusalis to apply
• the person making the decision has notwithdrawn the decision at a time when heor she had the capacity to do so
• the person making the decision has notappointed, after the decision was made, anattorney to make the specified decision
• the person making the decision has notdone anything clearly inconsistent with thedecision remaining a fixed decision.
2 Can advance decisions extend to refusinglife-sustaining treatment?Although advance decisions can be oral or inwriting, an advance refusal will only apply to
Mental Capacity Act tool kit •Advance decisions refusing treatment
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life-sustaining treatment where it is in writing,is signed and witnessed, and contains astatement that it is to apply even where life isat risk. Advance decisions cannot be used torefuse basic care, which includes warmth,shelter and hygiene measures to maintainbody cleanliness. This also includes the offerof oral food and water, but not artificialnutrition and hydration.
In an emergency or where there is doubtabout the existence or validity of an advancedecision, doctors can provide treatment thatis immediately necessary to stabilize or toprevent a deterioration in the patient untilthe existence, and the validity andapplicability, of the advance decision can beestablished.
3 Do advance decisions apply to individualssubject to compulsory mental healthlegislation?Where a patient is subject to compulsorytreatment under mental health legislation,an advance refusal relating to treatmentprovided for the mental disorder for whichcompulsory powers have been invoked willnot be binding, save in the case of electro-convulsive treatment (ECT) although thetreating professional should take such adecision into account. This could include, forexample, considering whether there are anyother treatment options available that are lessrestrictive. An agreed advance treatment planfor mental health conditions can be helpfuland would represent a kind of advancestatement, although it would not be bindingduring periods of compulsion.
