The Mental Capacity Act 2005

The Mental Capacity Act (MCA) is crucial to making decisions for a number of patients lacking capacity. Mental capacity refers to the ability to make a decision. Hence, it’s aim is to safeguard decision-making of those over 16 years-old who are unable to make decisions for themselves.

What is the MCA?

• The act has been in force since 2007 and applies to both England and Wales
• Involves care, treatment and support for everyone over the age of 16 who are unable to make some or all decisions for themselves
• Protects and promotes decision-making in those lacking capacity
• All healthcare professionals are to follow the five key principles

The Five Principles

1) Presume capacity

This essentially means you cannot assume that someone cannot make a decision for themselves because they have a certain medical condition or disability. In the first instance, the clinician must always presume the patient has capacity until proven otherwise.

2) Support decision-making

The clinician should make all efforts to support a patient with the decision-making process. All clinical staff must provide whatever is necessary to help the patient in making a decision e.g. visual aids. The patient, even when lacking capacity, should be involved in the decision-making process as much as possible.

3) Respect unwise decisions

Individuals have the right to make ‘unwise’ decisions. Just because an individual makes an unwise decision does not mean that they lack capacity or should not be making the decision. Determining something as wise or unwise is extremely subjective and individual. The patient’s decision will be influenced by their background and beliefs, therefore these should be taken in to account.

4) Work in the best interests

Any action or decision made should be done with the best interests in mind.

5) Choose the least restrictive option

If someone is acting on behalf of a patient lacking capacity, then they must consider decisions and options that would affect the patient’s beliefs and values the least.

Assessing Capacity

Capacity should be assessed when an individual is unable to make a particular decision at a particular time – therefore it should be time and decision-specific.

Four factors are required for adequate capacity, including the ability to:

• understand the information given
• retain the information to make a decision
• weigh up the information to make a decision
• communicate their decision – be it verbal, signals etc

If any of these aspects fail, then an individual may be lacking capacity.

Best Interests

Someone may need to make a decision for a patient as a result of them lacking capacity. The person making the decision may be a carer or the clinician responsible for the patient. Independent Mental Capacity Advocates (IMCAs) were created under this act to help make decisions for patients without any family or friends to represent them. Patients may also have chosen an individual under Lasting Powers of Attorney (LPA) – this is an individual who has been chosen to make health, welfare and/or financial decisions for the patient.

Summary

• Clinicians must follow the 5 key principles of the MCA
• The clinician should assess capacity, which is both time and decision specific
• A best interests decision may be necessary as a result of someone lacking capacity