NMC CBT Legal Frameworks, Consent, and Capacity 2 — Questions and Answers
Question 1: Under the Mental Capacity Act 2005, which is NOT one of the five statutory principles?
- A person must be assumed to have capacity unless established otherwise
- A person should not be treated as unable to make a decision because they make an unwise decision
- Capacity assessments must be conducted by a psychiatrist (Correct answer)
- Any act done for a person lacking capacity must be in their best interests
Correct answer: Capacity assessments must be conducted by a psychiatrist
The MCA does not require psychiatrist assessments. Any healthcare professional involved in the person's care can assess capacity.
The five principles: (1) Presumption of capacity; (2) Support to make decisions (all practicable steps); (3) Unwise decisions do not mean lack of capacity; (4) Best interests; (5) Least restrictive option. Capacity is decision-specific and time-specific. Any healthcare professional can assess — it does not require a psychiatrist.
Question 2: A patient with a valid ADRT refusing blood transfusion is admitted unconscious and haemorrhaging. What should the team do?
- Administer the transfusion as it is life-threatening
- Respect the ADRT and provide alternative treatment (Correct answer)
- Contact next of kin for consent
- Apply to the Court of Protection
Correct answer: Respect the ADRT and provide alternative treatment
A valid and applicable ADRT is legally binding under the MCA 2005, even if refusal may result in death.
Under MCA Sections 24-26, a valid ADRT for life-sustaining treatment must be: in writing; signed and witnessed; include a statement applying even if life is at risk. If met, it is legally binding. Overriding it could constitute assault. Provide all other appropriate care. Next of kin cannot override a valid ADRT.
Question 3: What legal framework governs compulsory detention of patients with mental disorders in England and Wales?
- Mental Capacity Act 2005
- Mental Health Act 1983 (as amended 2007) (Correct answer)
- Human Rights Act 1998
- Care Act 2014
Correct answer: Mental Health Act 1983 (as amended 2007)
The Mental Health Act 1983 (amended 2007) provides the framework for compulsory detention and treatment for mental disorders.
MHA 1983/2007: Section 2 = assessment (28 days); Section 3 = treatment (6 months, renewable); Section 4 = emergency (72 hours); Section 5(2) = doctor's holding power (72 hours); Section 5(4) = nurse's holding power (6 hours); Section 17A = community treatment orders. Applies to mental illness, learning disability, personality disorder.
Question 4: A nurse suspects elderly patient financial abuse by a family member. Under the Care Act 2014, what is their legal duty?
- Discuss with the family member first
- Raise a safeguarding concern with the local authority (Correct answer)
- Report to police immediately without informing others
- Document and wait for more evidence
Correct answer: Raise a safeguarding concern with the local authority
The Care Act 2014 Section 42 requires raising safeguarding concerns with the local authority when there is reasonable cause to suspect abuse or neglect.
Care Act Section 42: local authorities must enquire if an adult has care needs, is experiencing or at risk of abuse/neglect, and is unable to protect themselves. Document factually; raise safeguarding alert via Trust's safeguarding team; follow Trust policy; do not investigate or confront the alleged abuser. Six safeguarding principles: empowerment, prevention, proportionality, protection, partnership, accountability.
Question 5: What does 'Gillick competence' mean?
- A child under 16 with sufficient understanding to consent to or refuse medical treatment (Correct answer)
- A patient over 16 who lacks mental capacity
- An adult who refuses treatment against medical advice
- A child whose parents have given consent on their behalf
Correct answer: A child under 16 with sufficient understanding to consent to or refuse medical treatment
From Gillick v West Norfolk (1985): a child under 16 with sufficient understanding and intelligence to fully comprehend what is proposed.
Gillick competence (1985 House of Lords ruling): children under 16 can consent if they have sufficient understanding of the nature and implications of proposed treatment. It is decision-specific; courts have overridden Gillick-competent refusals to preserve life. For ages 16-17, the Family Law Reform Act 1969 presumes capacity to consent.
Question 6: What is the purpose of Deprivation of Liberty Safeguards (DoLS)?
- To allow detention under the Mental Health Act
- To provide legal authorisation for depriving a person who lacks capacity of their liberty when in their best interests (Correct answer)
- To enable staff to restrain violent patients
- To allow family members to make all healthcare decisions
Correct answer: To provide legal authorisation for depriving a person who lacks capacity of their liberty when in their best interests
DoLS authorise deprivation of liberty for a person lacking capacity in a hospital or care home when necessary, proportionate, and in their best interests.
DoLS (MHA 2007 amendment to MCA 2005) protect people who: lack capacity to consent to care arrangements; are in hospital/care home; whose care amounts to deprivation of liberty (continuous supervision, not free to leave). Following HL v Bournewood (2004 ECHR). Requires six assessments. Due to be replaced by Liberty Protection Safeguards.
NMC CBT Legal Frameworks, Consent, and Capacity 2
Under the Mental Capacity Act 2005, which is NOT one of the five statutory principles?