Individuals have a right to self-determination free from coercion or coaxing
Capacity under the Mental Health Act is defined as the ability to do all of the following:
Understand information relevant to the decision making process
Retain that information
Use or weight the information as part of the decision making process
Communicate that decision, by any interpretable means
Assessment of capacity is a two-step act:
Is the patient suffering from an impairment of the mind or the brain?
Does that impairment impede the patient’s mental capacity?
Principles when making a decision for someone who lacks capacity:
Every patient has the capacity to make decisions until proven otherwise
A patient cannot be assumed to lack capacity unless all practical steps which are taken to help him make a decision are unsuccessful
An unwise decision does not equate to a lack of capacity
Any decision made on behalf of the patient who lacks capacity must be in his best interests
There must be consideration as to how a decision made on behalf of a person can be achieved in a way which is least restrictive to his rights
Formal assessment of mental capacity can only be done by medical practitioners who have undergone training and whose names are registered with the Office of the Public Guardian
Beneficence
Promoting what is best for the patient
Confidentiality
Protects trust between doctor and patient
Notifiable diseases and conditions under the ID Act specify circumstances where confidentiality may be broken
Do no harm / non-maleficence
Balance the risk of harm of an intervention against the benefit
Equitable care / justice
Resources are limited
Priorities must be set such that in allocating resources, patients in similar situations should have the same access to the care provided
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