ethics- capacity

Question 1

what is capacity?

Answer 1

refers to someone’s ability to make a decision in medicine.

Question 2

important points on capacity:

Answer 2

Healthcare professionals must presume that all adults have capacity unless there is evidence to suggest otherwise.

Here are some important points on capacity:

A patient has capacity until proven otherwise

Capacity is decision-dependent

If a decision is strange and irrational, they may still have capacity.

Question 3

for someone to have capacity they must be able to:

Answer 3

Understand the information given to them

Retain the information

Use the information to make a decision

Communicate that decision

Question 4

assessing capacity- the functional test

Answer 4

Is the patient not able to make a particular decision?

This test involves determining whether or not the patient is able to make a specific decision at the time it needs to be made. This is not about the decision they make, but their ability to understand and consider the information relevant to the decision. The test examines whether the person can:

Understand information related to the decision

Retain that information long enough to make a decision

Use or weigh that information as part of the process of making the decision

Communicate their decision by any means.

Question 5

assessing capacity- diagnostic test

Answer 5

If the functional test shows that the patient is unable to make the decision, the diagnostic test examines whether this inability is because of an impairment of a number of things including:

Mental health conditions

Unconsciousness

Alcohol

Drugs

Dementia

Delirium

Severe learning disabilities

Brain damage

Question 6

capacity can fluctuate over time

Answer 6

The capacity can fluctuate over time or depending on the complexity of the decision. Therefore, the assessment should be repeated whenever necessary.

Also, the lack of capacity to make one decision does not imply the lack of capacity for another decision.

It is important to remember that capacity can fluctuate. Just because someone did not have the capacity to make a decision yesterday, does not automatically mean they lack capacity today.

Furthermore, a patient can have capacity for some decisions but not others. An elderly patient with dementia may be able to understand information relating to a blood test and be deemed to have the capacity to consent to this. However, they may not have the capacity to consent to complex surgery.

Question 7

who can assess capacity?

Answer 7

In a healthcare setting, the responsibility of assessing a patient’s capacity usually falls on the healthcare professional who is directly involved in the patient’s care at the time of the decision-making process.

The tests explained above should be used.

Sometimes capacity needs to be tested for major decisions, and therefore someone more experienced in assessing capacity may need to be involved

Question 8

what happens if someone doesn’t have capacity?

Answer 8

If someone doesn’t have capacity to make a decision about their care, the healthcare professionals treating them will have to make the decision for them.

The decision made by the healthcare professional must be in the ‘best interests’ of the patient.

Before concluding that someone does not have capacity, the healthcare professional should take appropriate steps to encourage the person to participate in any decisions that need to be made.

Question 9

what are best interests in medicine?

Answer 9

‘Best interests’ are considered when an adult lacks capacity to make a decision. The healthcare professional treating them will instead make the decision, according to what is best for that particular patient.

Question 10

considerations when deciding what is in the best interests of their patients

Answer 10

Patient’s past and present wishes

Any beliefs that the patient has that may have influenced their decision if they had capacity

The views of anyone named by the patient as someone to be consulted if they were to lose capacity/be in this position

The views of anyone that care for the patient

The views of any donee of a lasting power of attorney

The healthcare professional should NOT base any decisions made for the patient based on the patient’s appearance, age or any conditions of their behaviour.

Question 11

what is an advanced decision

Answer 11

People can make advance decisions to refuse treatment when they lack the capacity to make a decision in the future. It enables health professionals to know what treatments the patient does not want to be carried out if they find themselves lacking the capacity to make this decision.

The specific treatments and specific situations in which you do not want treatment need to be clearly stated in the advance decision.

A common example of an advance decision is the refusal of CPR when someone suffers a cardiac arrest. But other examples include refusal of ventilation and certain medications.

The advance decision must be made when the person has capacity to do so. It has to be written down, signed by the person themselves and by a witness.

Question 12

what is lasting power of attorney?

Answer 12

A person can give someone the power to make decisions about their health and welfare, if they lack the capacity to do this themselves, by creating a health and welfare LPA.

It is important that you understand that the person appointed as the attorney can only make these decisions if the patient is not able to make these decisions for themselves.

The decisions that are covered within a health and welfare LPA include:

Where the person lives

The person’s medical care

The social activities the person takes part in

The care of the person (diet, washing etc)

Question 13

ethical consideration for capacity in medicine

Answer 13

Autonomy: Autonomy is promoted by the capacity assessment, as it ensures all adults are presumed to have capacity unless there is significant evidence to suggest otherwise. However, if the capacity assessment is not used accurately, it has the ability to restrict the autonomy of some adults.

Beneficence/non-maleficence: Ensuring that those who do not have capacity cannot consent or refuse to consent to medical interventions limits the amount of harm that can happen as a result.

Justice: The current capacity assessment used ensures that adults are treated fairly. If someone is found not to have the capacity for one decision, it is not automatically assumed that they cannot consent to another intervention. Furthermore, it is ensured that capacity assessments are not based on someone’s appearance or age.

Question 14

how to answer questions on capacity in interviews?

Answer 14

Remember to explain what is meant by capacity when answering questions on it, as the interviewer needs to know that you understand the relevant terms.

Capacity and consent are closely linked, so make sure you try and incorporate the two when answering questions

It is easy to make your answers on capacity quite wordy and complex, so try to practise answering questions or pinning down a good definition to use in interviews. This will also demonstrate to your interviewer that you can explain complex topics concisely