Scenario 1 Case Based Discussion on Assessing Mental Capacity

Question 1  Discuss how you would assess whether Mrs Smith has capacity to refuse chemotherapy?

CURB Test!  1) Can the person communicate their decision?  2) Can they understand the information given to them?  3) Can they retain the information given to them?  4) Can they balance, weigh up or use the information?

Communication  Can they express the reasons why they don’t want chemotherapy?  Does she acknowledge that depression might play a part in decision making?

Understand  Check understanding on what chemotherapy would entail- purpose, length of treatment, side effects, addressed concerns?  Has the information been explained fully in a simple non-medical language?  Has she discussed with family/friends?

Retain  Can she retain the information you have just provided?  Can she remember conversation she had with the Consultant?

Balance  Is Mrs Smith able to weigh up the information available to make the decision?  Have other alternatives been discussed?

5 Principles 1. Every adult has the right to make his or her own decisions and must be assumed to have capacity to make them unless it is proved otherwise. 2. A person must be given all practicable help before anyone treats them as not being able to make their own decisions 3. Just because an individual makes what might be seen as an unwise decision, they should not be treated as lacking capacity to make that decision. 4. Anything done or any decision made on behalf of a person who lacks capacity must be done in their best interests. 5. Anything done for or on behalf of a person who lacks capacity should be the least restrictive of their basic rights and freedoms.

5 Principles 1. Every adult has the right to make his or her own decisions and must be assumed to have capacity to make them unless it is proved otherwise. 2. A person must be given all practicable help before anyone treats them as not being able to make their own decisions 3. Just because an individual makes what might be seen as an unwise decision, they should not be treated as lacking capacity to make that decision. 4. Anything done or any decision made on behalf of a person who lacks capacity must be done in their best interests. 5. Anything done for or on behalf of a person who lacks capacity should be the least restrictive of their basic rights and freedoms.

Question 2  What options are available to you in her management plan?

Options  Assess and treat the depression then reassess?  Enquire re family support and involve them in care?  Arrange further consultation with Consultant to address any further concerns?  If capacity, allow her to make own decision!!

Conclusion  Learning points  Assessing capacity  1. Work on the basis that every adult has the ability to decide how to proceed with their treatment, unless it is shown that they cannot understand information presented in a clear way.  2. The MCA CURB test is used to assess capacity.  4. Patients have the right to refuse treatment, even if you do not agree with their decision.

References  Mental Capacity Act  Mental Capacity Act 2005 Code of Practice