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Mental Capacity Case Examples

Michael

See The Five Principles of Mental Capacity.

Michael had a stroke 3 years ago. He has been unwell and is now in hospital. The doctor wants to undertake further tests involving a general anaesthetic. The doctor discusses the procedure with Michael who becomes anxious and repeatedly asks why he needs an anaesthetic. This is not an emergency but the doctor feels that Michael may lack capacity to consent as he does not seem to be able to understand and remember what the doctor is saying. So, the doctor consults Michael’s wife who explains that ever since the stroke Michael gets anxious when he is away from home and the people and things he is familiar with. She tells the doctor that it would help if she was there when the doctor explained the tests to Michael as she can reassure him and explain things to him.

The doctor discusses the tests again with Michael when his wife is present. Michael is at first reluctant to agree to the anaesthetic but his wife explains she will be there when he wakes up and that he will not have to stay in the hospital overnight. With the help of his wife, Michael understands what the doctor is saying and is able to make a decision and give his consent to the tests.

Margie

See The Five Principles of Mental Capacity.

As a result of a car accident a few years ago Margie is paralysed and also has brain damage. Margie has received significant compensation for her injuries. She wants to use part of the money on cosmetic surgery. Her family agree that she understands the financial implications of spending a portion of the compensation on cosmetic surgery. However, they are concerned that she does not understand the risks that the procedure will involve.

The cosmetic surgeon has had several consultations with Margie. She has made it clear that she understands the implications both physically and financially and is determined to have the surgery. She thinks it will increase her self esteem and confidence and that these benefits outweigh the potential risks. The surgeon also asks a colleague to discuss the implications of the surgery with Margie. His colleague concludes that Margie has the capacity to make the decision and makes a note in the health records.

Ridwaan

Ridwaan has dementia and lives in a residential care home. Like many people with dementia his mental capacity fluctuates. On most days he can make all the basic decisions about daily living such as washing, eating and drinking etc. However, sometimes he lacks capacity to make the most basic of decisions, such as what to eat.

On these occasions, a possible entry in the care records could be: “At lunch time today, Ridwaan lacked capacity to decide what to eat, so a decision about this was made in his best interests. At each mealtime we will assess his capacity to decide what he wants to eat. If Ridwaan has capacity to make this decision at any point he will decide what to eat”.

Jamal

See The Independent Mental Capacity Advocate (IMCA) Service.

Jamil is an adult with severe learning disabilities. Both his parents have recently died. Jamil needs heart by-pass surgery. This is the first time since his parents died that a decision needs to be made about Jamil, who has no other family, friends or anyone else to represent and support him. Although he is able to make decisions about his day to day life he lacks capacity to consent to the operation.

An IMCA will therefore be asked to find out as far as possible Jamil’s views and represent them to the doctor. The doctor will then decide whether or not it is in Jamil’s best interests to go ahead with the operation

Martin

See Providing Care or Treatment for people who have planned ahead.

Martin has recently been diagnosed as being in the very early stages of Alzheimer’s disease. He wants to ensure that if he lacks capacity in the future his personal values and preferences are taken into account when a decision is made on his behalf. He decides to appoint his daughter as a welfare attorney to make any personal welfare decisions if he loses capacity to make them himself. He talks through things which are important to him, such as wanting to stay near his friends, and to be able to go into a care home that allows pets. His daughter then registers the LPA.

If in the future Martin lacks capacity to decide where he should live, his daughter will have the authority to make this decision as his personal welfare attorney. She will be able to take account of the things her father has stated when considering what would be in his best interests.

Ike

See Providing Care or Treatment for people who have planned ahead.

Ike has witnessed a friend die of cancer. He decides that he does not want to receive chemotherapy or radiotherapy if he becomes seriously ill and is close to dying. Ike is concerned that if he is unable to make this decision, the doctors involved might make it for him. So, he makes an advance decision stating that if in future he becomes ill, he does not want to receive chemotherapy or radiotherapy. His advance decision includes a written statement confirming that he does not want chemotherapy or radiotherapy even if his life is at risk. Ike signs the advance decision and his close friend witnesses the signature.

The advance decision must be followed if and when it becomes relevant and the doctors involved are satisfied that it is valid and applicable.

Khalid

See Providing Care or Treatment for people who have planned ahead.

Khalid is vegetarian and has a degenerative condition. He wants to make sure that if he lacks mental capacity and needs people to help him with daily tasks, they take into account his personal beliefs. He therefore writes a statement explaining that he only wishes to receive vegetarian food. Khalid asks for the statement to be filed with his health records so that if in the future he can no longer make and communicate his own decisions he receives food in line with his wishes,

Interface with other Legislation, Policy and Procedures

A young person with a physical impairment and limited life experiences is being asked to consider what leisure opportunities they would like to participate in. In this case although you assess the client clearly has capacity their limited life experience means they are not empowered to use that capacity. The role of staff here is to think about strategies that encourage decision making and real choices, for example:

  • What information did you give and how?
  • Did you find out what really is available out there?
  • How did you encourage the young person to problem solve – budget, travel, equipment, company etc?

Your notes need to show not only that the individual has the capacity to make a decision but how you supported that decision making. The Mental Capacity Act is not just about who has capacity and who does not, it is about our duty to use enabling skills and evidence their use.

IMCA Guidance

A man who has a learning disability and autism receives funding from the county where he originally lived as a child, to live in a care home in a different area. The care home is closing and different accommodation needs to be identified. A care manager from the funding authority is involved and knows that the IMCA service provided in the area where the man currently lives, is the right service.

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