The Mental Capacity Act 2005
- The Principles
The Mental Capacity Act (MCA) 2005 relates to patients who do not have capacity and therefore, lack the ability to make decisions for themselves.
The Mental Capacity Act relates to a person’s ability or capacity to function and to make a particular decision at a particular time. Before looking at this in more detail I want to take a step back and look at the importance of this act and why it came into being.
The law traditionally identified that in many cases those with mental disorders would have a limited capacity to make decisions for themselves. When we apply this to medical or dental practices it means that the treatment will not be consented to by the patient as they lack the capacity to make decisions for themselves. In doing so we deprive the individual of their autonomy and that this explained by concept of justified paternalism. This can be defined as an act which the patient has not consented to and in some cases asked for but is provided with the intention of protecting them from coming into harm.
In our liberal society autonomy is promoted and this is something which is reflected in medical ethics. Paternalistic measures in contrast are frowned upon and are seen as a last resort to protect people coming from harm – in ethics this is known as the Harm Principle.
The Mental Capacity Act 2005 whilst acknowledging that we can act on someone else’s behalf should they lack capacity, sets out a series of safeguards to make sure that this is only done in exceptional circumstances and in the best interests of the patient.
The Principles of the MCA
The MCA is based on five guiding principles:
“A person must be assumed to have capacity unless it is established that he lacks capacity.
A person is not to be treated as unable to make a decision unless all practicable steps to help him to do so have been taken without success.
A person is not to be treated as unable to make a decision merely because he makes an unwise decision.
An act done, or decision made, under this Act for or on behalf of a person who lacks capacity must be done, or made, in his best interests.
Before the act is done, or the decision is made, regard must be had to whether the purpose for which it is needed can be as effectively achieved in a way that is less restrictive of the person's rights and freedom of action.”
Resources - I would strongly recommend reviewing the below documents for an overview on the topic- especially the Mental Capacity Act 2005 Code of Practice which gives a more detailed overview of how to apply the Act in practice:
The Mental Capacity Act 2005 - Section 1
The Mental Capacity Act 2005 Explanatory Notes - Section 1
The Mental Capacity Act 2005 Code of Practice - See Chapter 1+2