The Mental Capacity Act 2005 About those who are not able to make decisions for themselves (But not children or people who are mentally ill) About all kinds of decisions (e.g. financial) Not just healthcare Nevertheless it includes healthcare It raises important questions about withholding and withdrawing medical treatment

The Mental Capacity Act 2005 Withholding and withdrawing sometimes legitimate Not like suicide and euthanasia (always wrong) Depends of circumstances Depends on intention This makes it difficult to lay down rules Is there anything we can say?

The Mental Capacity Act 2005 (At least) two important goods at stake: Living well and dying well Cherishing Life and accepting death Giving needed treatment and avoiding futile (or burdensome) treatment Avoid under-treatment and over-treatment Some more anxious about under-treatment Some more anxious about over-treatment Important to remember BOTH these dangers

The Mental Capacity Act 2005 How does Mental Capacity Act deal with this?: Five ‘key principles’, essentially two: Presume and support capacity to make decisions If no capacity to decide then act in ‘best interests’ (best interests includes more that physical health) Two key new powers: Legally binding advance decision to refuse treatment Appointment of health and welfare attorney

The Mental Capacity Act 2005 From Catholic perspective ‘five key principles’ are acceptable if understood in Catholic sense Advance decisions can be legitimate can cause problems Attorney can be legitimate can cause problems The Guide neither forbids nor recommends these Two particularly sensitive issues: Refusing (and respecting refusal of) assisted nutrition and hydration Respecting (valid and applicable) clearly suicidal advance decisions

The Mental Capacity Act 2005 Artificial nutrition and hydration commonly taken as ‘medical treatment’ Act (and Code) clearly states that ANH can be refused This particularly problem if person is not dying (e.g. PVS patient) Understanding of John Paul II and other authorities is that ANH is basic care, rarely if ever to be withdrawn Nevertheless at end of life circumstances make even refusal of food and fluids a possible option

The Mental Capacity Act 2005 With attorney, be ready to discuss and if necessary to resist withdrawal against best interest With advance decision, how to deal with harmful refusal of ANH or clearly suicidal refusal Must these be respected? Ask carefully if valid and applicable This aspect of care taken from professional responsibility. Remaining question: what to do if you do not agree?