The Mental Capacity Act (MCA) 2005 provides a legal framework that protects mentally incapacitated individuals and guides decision makers during the decision-making process who are of age 16 years or over. The Act received the Royal Assent on 7 April 2005 and came into force on 1 April 2007.
Individuals have capacity if they can understand, remember, and use information that is appropriate to decide whether to consent to or refuse treatment (two-stage test). The Act introduces Advanced Decisions to Refuse Treatment (ADRT) while an Independent Mental Capacity Advocate (IMCA) service will provide help for individuals who have no intimate support network.
Various components of the Mental Capacity Act are as:
• Lasting Powers of Attorney (LPA)
• Court-appointed deputies (CADs)
• Advance decisions
• Research involving adults without mental capacity
Key principles of the Mental Capacity Act are:
I. Presumption of capacity
II. Right for individuals to be supported to make their own decisions
III. Unwise or eccentric decision
IV. Best interests
V. Less restrictive intervention
The Mental Capacity Act is determined through the two-stage test which comprises two components diagnostic component and functional component.
For decision making there are 3 significant models as:
1. Advance care planning
2. Substituted judgement
3. Best interests
Gillick’s Competence: It can be described as the ability of an under-age child to give valid consent.
Fraser Guidelines: According to the Fraser guidelines, there are five distinct conditions, all of which must be met for a child to be “competent and they are:
i. The young person must understand the advice being given.
ii. The young person cannot be convinced to involve parents/carers or allow the medical practitioner to do so on their behalf.
iii. It is likely that the young person will begin or continue having intercourse with or without treatment/ contraception.
iv. The young persons’ physical or mental health (or both) is likely to suffer unless they receive treatment/ contraception.
v. The young person’s best interests require administration of contraceptive advice, treatment or supplies without parental consent.
Jehovah’s Witness: These are the members of a religious organisation of American origin who accept some Christian ideas and have some deeply set core values. refuse the transfusion of blood as well as that of primary blood components (red cells, plasma cells, white cells, and platelets).
Clinicians need to choose if they would be willing to accept these limitations while managing the patient at the time of surgery. If at any point there occurs a conflict between religious, medical, and ethical opinions, the clinician must resort to the High Court to attain a fair and impartial hearing.
Jaypee Brothers Medical Publishers organises a course regarding MRCOG exam. The course includes webinars on various significant topics. The upcoming webinar is on the “Discussion on March 2017 Questions” that will be organised on April 06, 2019.
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