Legal aspects

Question 1

What is consent?

Answer 1

Permission to undergo a specific activity such as medical treatment and surgery

Question 2

What determines the validity of consent?

Answer 2

If the consenting individual has capacity

Question 3

What is capacity?

Answer 3

The ability to enter into valid contracts

Question 4

Describe the assessment of incapacity

Answer 4

Is the patient able to do all of the following?

1. Understand the information
2. Retain the information
3. Weigh-up the benefits and risks
4. Communicate their decision

If yes ➔ patient has capacity

If no ➔ patient does not have capacity

Question 5

Define ‘presumption of capacity’ as outlined in the Mental Capacity Act 2005

Answer 5

A person (18+) is assumed to have capacity until established otherwise

Question 6

What is informed consent?

Answer 6

Consent provided that both the following are supplied:

• Sufficient information on all of:
  
  • Diagnosis
  • Prognosis
  • Treatment options
  • Risks
• Adequate time to assess the information

Question 7

Name the two types of consent

Answer 7

• Implied consent: cooperation or no objection
• Expressed consent: explicit permission

Question 8

What are advance statements?

Answer 8

Preferences made during a time of greater capacity

For use in situations when capacity is lost

Typically produced for chronic progressive illnesses

Question 9

What is the difference between an advance decision and an advanced statement?

Answer 9

• Advance decision:
  
  • Refusal of a specific type of treatment in the future ^eg. DNACPR
  • Legally binding
• Advanced statement
  
  • Preference of treatment in the future
  • Not legally binding
  • Should be considered when making treatment decisions

Question 10

What makes an advanced decision legally binding?

Answer 10

• Written by the patient
• Signed by the patient
• Signed by a witness ^eg. Solicitor
• Expressed statement that decision stands ‘even if life is at risk’

Question 11

What are Lasting Powers of Attorney (LPA)?

Answer 11

• The appointment of an attorney
• To make health and welfare decisions
• Should the patient lose capacity in the future

Question 12

What is the Mental Capacity Act 2005?

Answer 12

Legislation governing the care and treatment of people lacking capacity

Question 13

Outline the five key principles in Section 1 of the Mental Capacity Act 2005

Answer 13

1. Presumption of capacity
2. All practical steps taken to allow autonomy
3. Allow unwise decisions
4. Operate in best interests if lack capacity
5. Least restrictive option

Question 14

What is Section 5 of the Mental Capacity Act 2005?

Answer 14

Protection from liability when providing care and treatment to an incapacitated adult

• Authorised healthcare workers can care and treat
• In the best interest of the incapacitate patient
• Without fear of liability
  
  • ^eg. Physical restraint and trespass

Question 15

What are Deprivation of Liberty Safeguards?

Answer 15

Legislations governing the deprivation of liberty of people lacking capacity

An accompanying piece to the MCA 2005

Question 16

What is the Mental Health Act 1983/2007?

Answer 16

Legislation governing the care and treatment of mental disorder

Excludes substance dependency or sexual deviancy

Question 17

What are the principles of the Mental Health Act 2007?

Answer 17

1. Decisions taken with view to minimise harm done by mental disorder, maximise safety and health and patient and protect the public
2. Least restrictive alternative intervention
3. Recognise and respect the diverse needs, values, circumstances of each patient. Consider wishes and feelings
4. Involvement of patient, family, and carers
5. Use resources in the most effective, efficient, and equitable way.

Question 18

What are the five commonly used civil sections of the Mental Health Act 2007?

Answer 18

• Section 2
• Section 3
• Section 4
• Section 5(2)
• Section 5(4)

Question 19

What is a Section 2 of the Mental Health Act?

Answer 19

Assessment (and treatment) of mental health disorder

Max 28 days

Used in community and inpatient

Question 20

Who must be present to initiate a Section 2 of the Mental Health Act?

Answer 20

Both:

• Approved Mental Health Professional (AMHP)
• Registered Medical Practitioner (RMPs)

One must be Section 12(2) approved

Question 21

What is a Section 3 of the Mental Health Act?

Answer 21

Treatment of mental health disorder

Max 6 months

Used in community and inpatient

Question 22

Who must be present to initiate a Section 3?

Answer 22

Both:

• Approved Mental Health Professional (AMHP)
• Registered Medical Practitioner (RMPs)

One must be Section 12(2) approved

Question 23

What is a Section 4?

Answer 23

Emergency assessment

Used when Section 2 is unsuitable ^eg. delays

Max 72 hours

Used in community and A+E

Question 24

Who must be present to initiate a Section 4?

Answer 24

Registered Medical Practitioner (RMP)

Question 25

What is a Section 5(2)?

Answer 25

**Detainment** of an inpatient for completion of **Mental Health Act assessment** Max **72 hours** Only used for **inpatients**

Question 26

Who must be present to initiate a Section 5(2)?

Answer 26

Registered Medical Practitioner (RMP)

Question 27

What is a Section 5(4)?

Answer 27

**Detainment** of an inpatient for **medical assessment** Max **6 hours** Only used for **inpatients**

Question 28

Who must be present to initiate a Section 5(4)?

Answer 28

Senior nurse

Question 29

What is a Section 136?

Answer 29

Police power to **transfer** an individual from a public place to a **place of safety** for assessment Max 24 hours

Question 30

What is a Section 17?

Answer 30

Leave from the ward Used whilst under a Section 2 or 3 Used to test safety to point of discharge Allows patient to be brought back into ward if terms of leave are violated

Question 31

Outline the appeals process for patients under Section

Answer 31

Patients can appeal to the following: * Section 2: Tribunal within 14 days * Section 3: Hospital manager panel and tribunal * CTO: Tribunal

Question 32

What is a Community Treatment Order (CTO)?

Answer 32

Allows patient to leave hospital Must return to hospital for treatment and follow-up Treatment is necessary for patient health and safety, and safety to the public Failure to comply ➔ recall to hospital

Question 33

Outline the doctor's responsibility in cases of abuse or neglect

Answer 33

All doctors have a duty to act on any concerns they have about the safety or welfare of a child or young person. Decisions made about children and young people must be made in their best interests.