Tag Archives: capacity

MCA: Advance decision to refuse treatment

On October 25th 2007 22 year old EG gave birth to twins at the Royal Shrewsbury Hospital. A few hours later she was dead because she refused to accept a blood transfusion. EG was a devout Jehovah’s witness. She suffered a sudden haemorrhage and bled to death following a natural delivery. EG had already signed a form before the birth refusing blood in such an event.

According to newspaper reports staff at the hospital tried to get EG’s husband and wider family to consent to the blood transfusion on her behalf but they would not.

  • Is this ‘valid and applicable’ as an advance decision to refuse treatment?
  • What about the notion that ‘decision-makers should not be motivated by a desire to bring about the person’s death’?
  • What do you make of the staff asking EG’s family to overrule her decision?
  • If the family had consented would the transfusion have been legal?
  • If not – would the family have been liable or the staff who gave it?
  • Who was the legal decision-maker in this situation?

After the mental capacity assessment

Assessing mental capacity is one thing but what happens next? What must we do once we know that a person lacks the mental capacity to make this particular decision at this particular time?

 

 

Who put us in charge?

A short video introduction to the principles of the mental capacity act 2005.

Who put us in charge?

If you’d like to arrange training for your staff please complete and send the contact form below.

Privileged glimpses 11: Risk-free is impossible

life without riskThis series of blog posts first appeared a few years ago on a now defunct blog called ‘Care Training’. It was inspired by the training maxim of ‘making the unconscious conscious’. It is intended to take what really ought to be the most basic principles of health and social care and put them down on paper. The series isn’t only an exercise in stating the obvious though whatever the title might suggest. It’s actually intended as a philosophical foundation manual for workers and informal carers to help them get their care ‘on track’ and then to keep it that way.

 Risk free is impossible – managed risk is the way to go.

Individual v Organisational risk

There is much more to the notion of risk than meets the eye. Many care workers think that it is their job to prevent service-users from taking any risks at all but this is not possible. In fact, even if it was possible to prevent people from taking any risks it would not be the right thing to do.

Life without risk would be life without living. It is only through accepting a level of risk in our daily lives that we are able to do anything at all. In fact, even doing nothing is risky. The risk to mental health from boredom and unchanging routine is as great as the risk to our physical health from inaction and lack of stimulating activities.

All activity, from making a cup of tea to crossing the road or even going to the toilet must involve some degree of risk in order for the service-user to maintain or develop skills. There is always a risk of failure when learning to do new things and on occasion that failure can result in some form of harm.

The trick then is to help people to understand the individual risk they are proposing to take. If they cannot understand it (for example if their mental capacity is impaired) then the risk becomes an organisational risk. In that case the organisation that creates the risk/activity for them must manage that risk to bring it down to manageable proportions. This does not necessarily mean remove the risk – simply manage it.

Obviously some things carry more risk than others. An activity that involves crossing the road with supervision might be considerably safer than the decision to go sky-diving but the principle still holds. The task is to make the risk manageable.

Just imagine how empty your life would be without risk. If we need to take risks in order to have a fulfilling life is it not just as important for our service-users?

Just as nobody has the right to remove risk from your life so you do not have the right to remove all risk from the lives of your service-users.

Types of risk

However – you really do have an obligation to manage the risks taken by those service-users who do not understand the risks they take and sometimes to prevent the more extreme or unnecessary risks.

So we need to determine:

  1. Is it an individual or an organisational risk?
  2. Is the risk manageable?
  3. What are the ‘reasonable foreseeable’ outcomes?
  4. Do we need to prevent the person from taking this risk or can we support them in it?

You can follow the entire blog series as it develops here.