Ethics+ +Law+Webinar+& 40 ONLINE+COPY& 41

Ethics & Law
Webinar
Common Ethics & Law
Question Topics
Gifts
Fraser guidelines Confidentiality
Gillick competence Coroner referral
Section 2/3/4/5/136 Consent to treatment
Jehovah’s Witness Refusal of treatment
DVLA restrictions Privacy
Child protection
Death certificates
The General Medical Council (GMC) sets out good medical practice
guidance for doctors.
Which ethical principle means promoting what is in the patient’s
best interests?
A. Autonomy
B. Beneficence
C. Non‐maleficence
D. Justice
E. Judicial precedent
The General Medical Council (GMC) sets out good medical practice
guidance for doctors.
Which ethical principle means promoting what is in the patient’s
best interests?
A. Autonomy
B. Beneficence
C. Non‐maleficence
D. Justice
E. Judicial precedent
Good Medical Practice: Ethical Principles
Autonomy ‘self‐rule’: Respecting and following the patient’s decisions in the

management of their condition.
Beneficence: Promoting what is in the patient’s best interests.
Non‐maleficence: Avoiding harm.
Justice: Doing what is good for the population as a whole.

A 31 year old Jehovah’s Witness was in a car accident and brought
into the emergency department. He has lost a massive amount of
blood. He is given IV fluids. He is in critical condition and blood
products are needed but he refuses any form of blood products due
to his religious beliefs.
What is the SINGLE most appropriate next step?
A. Transfuse blood against his will

B. Respect his decision and do not transfuse blood
C. Contact the police
D. Involve social services
E. Seek legal advice
A 31 year old Jehovah’s Witness was in a car accident and brought
into the emergency department. He has lost a massive amount of
blood. He is given IV fluids. He is in critical condition and blood
products are needed but he refuses any form of blood products due
to his religious beliefs.
What is the SINGLE most appropriate next step?
A. Transfuse blood against his will

B. Respect his decision and do not transfuse blood
C. Contact the police
D. Involve social services
E. Seek legal advice
Adult Consent to Treatment
- Over 18 years old
- You must respect a competent patient’s decision to refuse an

investigation or treatment, even if you think their decision is wrong
or irrational.
Jehovah’s Witness
Prohibit blood transfusions

- Variable acceptance of plasma/platelets etc (don’t assume!)
Those who you must not transfuse in an emergency:

- Conscious patients with capacity, actively declining (>18 years)
- Advanced directive
- Blood refusal card
- Lasting power of attorney
If not an absolute emergency:

- Seek legal advice
A 17 year old boy is brought to A&E by his friend. He has had a cough for 2
days. He is tachycardic 140bpm, BP 60/30 and hypoxic with sats of 90% on
4L. He has a past medical history of metastatic rhabdomyosarcoma and is
currently enrolled in a Phase Two Clinical Trial because he has failed all
standard treatment options. He tells you he doesn't want to live anymore and
he can’t stand to be treated like an animal, constantly poked and prodded.
He says he doesn’t want treatment and wants to die. He then starts to
become unresponsive. What should you do?
A. Respect the patient’s wishes to withhold antibiotics

B. Discuss with patient parents and if they agree, allow patient to self discharge
C. Refer to the hospital legal team
D. Comprise and give oral antibiotics
E. Administer IV antibiotics against his will
A 17 year old boy is brought to A&E by his friend. He has had a cough for 2
days. He is tachycardic 140bpm, BP 60/30 and hypoxic with sats of 90% on
4L. He has a past medical history of metastatic rhabdomyosarcoma and is
currently enrolled in a Phase Two Clinical Trial because he has failed all
standard treatment options. He tells you he doesn't want to live anymore and
he can’t stand to be treated like an animal, constantly poked and prodded.
He says he doesn’t want treatment and wants to die. He then starts to
become unresponsive. What should you do?
A. Respect the patient’s wishes to withhold antibiotics

B. Discuss with patient parents and if they agree, allow patient to self discharge
C. Refer to the hospital legal team
D. Comprise and give oral antibiotics
E. Administer IV antibiotics against his will
Consent
- At 16 it is legally presumed that young people have the ability to

make decisions about their own care.
- However a minor may not choose to die (<18 years old)

If no time Emergency treatment should be delivered
If time (elective) - seek court clarification
(blood or food)
A 14 year old girl comes requesting emergency contraception. Her
current sexual partner is 15 years old. She does not want her
parents to know she is sexually active.
What is the SINGLE most appropriate action?
A. Inform her parents

B. Advise her about safe sex and prescribe emergency contraception
C. Inform her that it is illegal to be having sex at her age
D. Contact the police
E. Contact the local safeguarding officer

Fraser Guidelines - Contraception (<16 years old)
● Understand the professional's advice

● Cannot be persuaded to inform their parents
● Likely to begin, or to continue having, sexual intercourse with or
without contraceptive treatment
● Physical or mental health, or both, are likely to suffer
● Best interests require them to receive contraceptive advice or
treatment with or without parental consent
Gillick competence - Consent to treatment
Children under the age of 16 can consent to medical treatment if they

have sufficient maturity and judgement to enable them fully to understand
what is proposed.


Red flags
- Sexual activity with a child under 13 is a criminal offence and

should always result in a child protection referral!
- Underage sexual activity should always be seen as a possible

indicator of child sexual exploitation.
A 14 year old girl comes requesting the oral contraceptive pill. Her

B. Advise her about safe sex and prescribe oral contraceptive pill
A 14 year old girl comes requesting the oral contraceptive pill. Her

B. Advise her about safe sex and prescribe oral contraceptive pill
Red flags
- Sexual activity with a child under 16 is a crime

current sexual partner is a teacher at her school. She does not want
her parents to know she is sexually active.

current sexual partner is a teacher at her school. She does not want
her parents to know she is sexually active.

Red flags
- Sexual activity with a child under 16 is a crime
- Anyone in a position of trust

Teacher / Doctor / Carer
A 25 year old patient with a known history of schizophrenia has been treated
for a community acquired pneumonia and was going to be discharged
tomorrow. However over the past few days the nurses report he has been
acting differently and today he has been found in the store room digging into
his arms with needles. You treat the wounds and ask him what happened.
He tells you he was trying to remove the bugs ‘they’ have put into him. You
begin taking him back to his bed but he says he wants to go home.
What ‘power’ gives you the right to hold him for assessment?
A. Mental Capacity Act

B. Section 2
C. Section 3
D. Section 5 (2)
E. Section 136
A 25 year old patient with a known history of schizophrenia has been treated
for a community acquired pneumonia and was going to be discharged
tomorrow. However over the past few days the nurses report he has been
acting differently and today he has been found in the store room digging into
his arms with needles. You treat the wounds and ask him what happened.
He tells you he was trying to remove the bugs ‘they’ have put into him. You
begin taking him back to his bed but he says he wants to go home.
What ‘power’ gives you the right to hold him for assessment?
A. Mental Capacity Act

B. Section 2
C. Section 3
D. Section 5 (2)
E. Section 136
The Mental Health Act (1983)
Evoked to treat psychiatric illness in non‐consenting patients.
● Section 136
● Section 2
● Section 3
● Section 4
● Section 5 (2)
● Section 5 (4)
Section 136: Police power to detain someone
● Applied by police
● Used to take them to a place of safety
● Lasts 72hrs
Section 4: Emergency admission to hospital order
• Applied by one doctor (usually a GP) and an approved social worker/relative
• Urgent necessity is demonstrable
• Lasts 72 hours
• May be converted to a Section 2 or 3

Section 5 (2): Emergency doctors holding power
• Applied by any doctor on an inpatient to enable psychiatric assessment
• 72 hours duration
• Good practice to convert this to a Section 2 or 3
Section 5 (4): Emergency (specialist) nurses holding power
• Lasts 6 hours
Section 2: Admission for assessment order (from community)
• Applied by an Approved Mental Health Professional and two doctors

(usually a psychiatrist and a GP)
• 28 days duration
• May be converted to a Section 3 (section 2 can not be renewed)
• The patient has a right of appeal to a tribunal within 14 days of detention

Section 3: Admission for treatment order
• Applied on a patient already with a mental disorder (or under section 2)
• 6 months duration then reviewed

An 80 year old patient presents to A+E following a fall. She had a history of Alzheimer’s
dementia and COPD. Her daughter is concerned how she would cope at home. She has
been trying to get her to move into a nursing home for several years. You discuss
discharge location with the patient. She is adamant that she wants to go home. She
says that knows to stay in one place and wait for people who come to help her but she
would rather die than go to a nursing home. Her daughter says she doesn’t really
understand the risks because of her dementia, this fall is evidence of that, and she
should be placed in a nursing home. What should you do?
A. Respect her wishes and discharge her to her own home

B. Return to discuss this again with the patient later - if she can remember you and
the conversation then agree to discharge her home
C. Arrange to discharge her to a nursing home
D. Trial a nursing home placement with the option of her going home if she isn’t happy
E. Arrange a formal capacity assessment by Psychiatry
An 80 year old patient presents to A+E following a fall. She had a history of Alzheimer’s
dementia and COPD. Her daughter is concerned how she would cope at home. She has
been trying to get her to move into a nursing home for several years. You discuss
discharge location with the patient. She is adamant that she wants to go home. She
says that knows to stay in one place and wait for people who come to help her but she
would rather die than go to a nursing home. Her daughter says she doesn’t really
understand the risks because of her dementia, this fall is evidence of that, and she
should be placed in a nursing home. What should you do?
A. Respect her wishes and discharge her to her own home

B. Return to discuss this again with the patient later - if she can remember you and
the conversation then agree to discharge her home
C. Arrange to discharge her to a nursing home
D. Trial a nursing home placement with the option of her going home if she isn’t happy
E. Arrange a formal capacity assessment by Psychiatry
Mental capacity
What is it to lack capacity?
What are the major principles of the mental capacity act?
How do we determine who has capacity?
Does a diagnosis of dementia affect your capacity?
If she can’t remember you or the conversation you had does she still have capacity?
If someone lacks capacity who makes the decisions?

Mental capacity
What is it to lack capacity?
The Mental Capacity Act 2005 defines lack of capacity in the following way:
“A person lacks capacity in relation to a matter if, at the material time, he is

unable to make a decision for himself in relation to the matter because of an
impairment of, or a disturbance in the functioning of, the mind or brain”.
Mental capacity
What are the major principles of the mental capacity act?
Five principles:
1) Everyone has capacity until it is established that they lack it
2) You must do everything you can to facilitate decision making
3) A person should not be judged to lack capacity because they make an unwise
decision
4) An act/decision done under the act must be in their best interests
5) It must be least restrictive to their rights and freedoms
Mental capacity
How do we determine who has capacity?
Capacity has four part:
1) to understand the information relevant to the decision

2) to retain that information
3) to use or weigh that information as part of the process of making the decision
4) to communicate his decision
Mental capacity
Does a diagnosis of dementia affect your capacity?
Lack of capacity cannot be demonstrated by referring to a person’s age or

appearance, condition or any aspect of their behaviour.
Capacity is about the ability to take a particular decision at the time it needs to be
taken. It is decision-specific and time-specific.
Mental capacity
If she can’t remember you or the conversation you had does she still have
capacity?
Capacity is about the ability to take a particular decision at the time it needs to be
taken. It is decision-specific and time-specific.
Mental capacity
If someone lacks capacity who makes the decisions?
Try to establish the person’s views

Consult others;
● Friends/relatives
● Named person
● Carers
● Lasting Power of Attorney
● Deputy of the Court of Protection
● Independent Mental Capacity Advocate (IMCA)
A 65 year old man is brought to A+E by his wife. His past medical history includes renal
transplantation 5 years ago for Adult Polycystic Kidney disease and since then he has remained
well. The patient is very drowsy. His wife tells you he has had a cough for 3 days and that this
morning he hasn’t woken up properly. His CXR shows a right sided pneumonia involving most of
his right lung field. He is profoundly hypoxic on maximal oxygen therapy. ITU review and agree he
required mechanical ventilation +/- inotropes. You discuss this with his wife who tells you she is a
lawyer and that her husband has previously told her and other friends, on many occasions, that
he would never want to be ventilated. His father died on ITU while ventilated and he found it very
undignified. She says he has made a verbal advanced decision and that ventilating him would
amount to assault. What is the SINGLE most appropriate action?
A. Respect his valid advanced decision

B. Ask to verify this with a second person who has heard him make this declaration, and
if this is true then respect his wishes
C. Discuss with your hospital's legal team
D. Proceed with the plan to mechanically ventilate him, despite the information you have
been given
E. Persuade his wife to consent to ventilation on his behalf
A 65 year old man is brought to A+E by his wife. His past medical history includes renal
transplantation 5 years ago for Adult Polycystic Kidney disease and since then he has remained
well. The patient is very drowsy. His wife tells you he has had a cough for 3 days and that this
morning he hasn’t woken up properly. His CXR shows a right sided pneumonia involving most of
his right lung field. He is profoundly hypoxic on maximal oxygen therapy. ITU review and agree he
required mechanical ventilation +/- inotropes. You discuss this with his wife who tells you she is a
lawyer and that her husband has previously told her and other friends, on many occasions, that
he would never want to be ventilated. His father died on ITU while ventilated and he found it very
undignified. She says he has made a verbal advanced decision and that ventilating him would
amount to assault. What is the SINGLE most appropriate action?
A. Respect his valid advanced decision

B. Ask to verify this with a second person who has heard him make this declaration, and
if this is true then respect his wishes
C. Discuss with your hospital's legal team
D. Proceed with the plan to mechanically ventilate him, despite the information
you have been given
E. Persuade his wife to consent to ventilation on his behalf
Advanced decisions
What do advanced decisions cover?
Who can make them?
When are they applicable?
How are they made?
Do they need to be in writing?

Advanced decisions
What do advanced decisions cover?
Refusal of treatment when you lack capacity to refuse yourself
Can be expressed in layman’s terms
Some treatments have special rules (we’ll come to that shortly)

Advanced decisions
Who can make them?
Anyone over 18 with capacity

Advanced decisions
When are they applicable?
● When the person lacks capacity to consent to a treatment or the continuation

of a treatment
● When they meet the criteria laid out in the advanced decision - these may be
quite specific
Advanced decisions
How are they made?
Can be made in layman’s terms

Specific - regarding both the circumstances and the treatment
Verbally vs written?
Advanced decisions
Do they need to be in writing?
If it is a refusal of life-sustaining treatment

Your GP practice manager asks you to speak to police officers who want information
regarding one of your patients. They tell you that they need the medical records of a
young woman registered at your surgery that is currently in police custody. You ask if
she has consented and they say she declined. They argue that she seems psychotic
and the forensic medical examiner needs more information. They state that section
29(3) of the Data Protection Act 1998 states they do not need consent. They ask for
copies of her medical records. What is the SINGLE most appropriate action?
A. Refuse to give them the information, you are bound by confidentiality

B. Ask them to return with a court order for this information, and if they do so then
give them the information requested
C. Give them full copies of the patient's medical records
D. Give them a list of her past medical history only
E. Ask them to put you in contact with the Forensic Medical Officer caring for this
patient to discuss the case with them directly
Your GP practice manager asks you to speak to police officers who want information
regarding one of your patients. They tell you that they need the medical records of a
young woman registered at your surgery that is currently in police custody. You ask if
she has consented and they say she declined. They argue that she seems psychotic
and the forensic medical examiner needs more information. They state that section
29(3) of the Data Protection Act 1998 states they do not need consent. They ask for
copies of her medical records. What is the SINGLE most appropriate action?
A. Refuse to give them the information, you are bound by confidentiality

B. Ask them to return with a court order for this information, and if they do so then
give them the information requested
C. Give them full copies of the patient's medical records
D. Give them a list of her past medical history only
E. Ask them to put you in contact with the Forensic Medical Officer caring for
this patient to discuss the case with them directly
Confidentiality
Confidentiality is an ethical principle (in addition to a legal duty)
However there are times when it must be broken
Does capacity play a role?
What about the Data Protection Act?
In this case
Confidentiality
When can confidentiality be broken?
1) With consent
2) Disclosure is to the benefit of a patient that lacks capacity
3) Required by law
4) In the public interest
Confidentiality
Legal disclosures - should be done if required by statute/requested by judge or

court
There are lots of laws that require disclosure - infectious disease, social care,
terrorism, road traffic act, gun/knife crimes
HOWEVER you should be satisfied it is required by law and only disclose relevant
information
Ideally you should inform patient of the disclosure

Confidentiality
Does capacity play a role?
Yes - in this case you should gauge if disclosure is in their best interests e.g.
disclosure for social care
But think - can this wait?
Must share with lasting power of attorney

Confidentiality
What about the Data Protection Act?
This section of the Data Protection act means that information can be disclosed in
certain circumstances but does not compel disclosure
A 29 year old man is admitted to ITU with severe hypoxia for mechanical
ventilation. He is found to be HIV positive and is diagnosed with Pneumocystis
jirovecii pneumonia following a bronchoalveolar lavage. Despite full medical
therapy he dies. You are asked to complete his death certificate. His boyfriend, a
law student, comes to see you and begs you not to put HIV on his death certificate
as his family did not know he was gay. He says he knows the patient would not
want his family to know and you’re meant to keep things confidential. That
shouldn’t have changed just because he is dead. How should you proceed?
A. Refer to the Coroner
B. Complete his death certificate: 1a) Pneumocystis jirovecii pneumonia
C. Complete his death certificate:
1a) Pneumocystis jirovecii pneumonia, 1b) human immunodeficiency virus
D. Complete his death certificate:
1a) Human immunodeficiency virus, 1b) Pneumocystis jirovecii pneumonia
E. Inform his family of his diagnosis before completing the death certificate
A 29 year old man is admitted to ITU with severe hypoxia for mechanical
ventilation. He is found to be HIV positive and is diagnosed with Pneumocystis
jirovecii pneumonia following a bronchoalveolar lavage. Despite full medical
therapy he dies. You are asked to complete his death certificate. His boyfriend, a
law student, comes to see you and begs you not to put HIV on his death
certificate as his family did not know he was gay. He says he knows the patient
would not want his family to know and you’re meant to keep things confidential.
That shouldn’t have changed just because he is dead. How should you proceed?
A. Refer to the Coroner
B. Complete his death certificate: 1a) Pneumocystis jirovecii pneumonia
C. Complete his death certificate:
1a) Pneumocystis jirovecii pneumonia, 1b) human immunodeficiency virus
D. Complete his death certificate:
1a) Human immunodeficiency virus, 1b) Pneumocystis jirovecii pneumonia
E. Inform his family of his diagnosis before completing the death certificate
Death Certification
This man has died of a complication of HIV
1a) immediate cause of death

1b) and c) lowest line is causative disease/process
2) contributing conditions
Which of these is NOT a reason to refer to the Coroner?
A. The cause of death is unknown

B. The deceased was not seen by the certifying doctor either after
death or within 7 days before death
C. Death may be due to an accident
D. Death may be due to self-neglect or neglect by others
E. Death may be due to the deceased employment
Which of these is NOT a reason to refer to the Coroner?
A. The cause of death is unknown

B. The deceased was not seen by the certifying doctor either
after death or within 7 days before death
C. Death may be due to an accident
D. Death may be due to self-neglect or neglect by others
E. Death may be due to the deceased employment
Death certificate
Reasons for referral to the coroner are as follows (derived mainly from paragraph 5 of the Notes for Doctors
with the MCCD):
- the cause of death is unknown
- the deceased was not seen by the certifying doctor either after death or within 14 days before death
- the death was violent or suspicious
- the death was unnatural
- the death may be due to an accident (whenever it occurred)
- the death may be due to self-neglect or neglect by others
- the death may be due to an industrial disease or related to the deceased’s employment
- the death may be due to an abortion
- the death occurred during an operation or before recovery from the effects of an anaesthetic
- the death may be a suicide
- the death occurred during or shortly after detention in police or prison custody
- the death occurred while the deceased was subject to compulsory detention under the Mental Health
Act or a Deprivation of Liberty Safeguards authorisation (DoLS)
- for any other concerning feature
Death certificate
Or more briefly:
● You don’t know why they died
● You haven’t seen them in the last 14 days
OR you haven’t seen their body
● Situational - violent, accident, suicide, neglect, industrial
● Operative - post-op or related to a termination of pregnancy
● Retained against their will - Police custody, MCA, MHA, DOLS
A 46 year old man has been seen by you in the oncology outpatient
department a number of times. He has completed his treatment and
you inform him that his follow up imaging is disease free. He is
extremely grateful and offers you a designer watch as a gift.
A. Initially refuse, but accept if he takes offense

B. Accept it with gratitude
C. Ask him to make a donation to charity
D. Ask him to donate it to the ward
E. Politely decline the gift
A 46 year old man has been seen by you in the oncology outpatient
department a number of times. He has completed his treatment and
you inform him that his follow up imaging is disease free. He is
extremely grateful and offers you a designer watch as a gift.
A. Initially refuse, but accept if he takes offense

D. Ask him to donate it to the ward
Gifts from patients
You should refuse gifts where they could be perceived as an abuse of trust,
and must not put pressure on patients or their families to make donations to
other people or organisations.
Accepting an expensive gift can adversely affect the doctor-patient

relationship and may be considered a conflict of interest.
There is no current official monetary cut off

but > £100 should be declared!
A 76 year old woman has been treated on your ward for a
community acquired pneumonia. On the day of discharge, she
hands to you a large hamper of chocolate, champagne and cheeses
to distribute between the staff.
A. Initially refuse, but accept if she takes offense

D. Ask him to donate money to the ward instead
A 76 year old woman has been treated on your ward for a
community acquired pneumonia. On the day of discharge, she
hands to you a large hamper of chocolate, champagne and cheeses
to distribute between the staff.
A. Initially refuse, but accept if she takes offense

D. Ask him to donate money to the ward instead
Gifts from patients
Small token of appreciation from a patient.
Refusing may cause embarrassment or harm the doctor-patient relationship

DVLA + Driving restrictions
● Seizures + epilepsy
● Acute coronary syndrome
● Insulin-controlled diabetes mellitus

A 28-year-old woman has a tonic-clonic seizure lasting 3 minutes.
This is her first seizure, which does not appear to have been
precipitated by an acute event. Serum electrolytes, an ECG and CT
head are normal. How long should the patient refrain from driving?
A. 3 months
B. 6 months
C. 12 months
D. 18 months
E. Ban from driving
A 28-year-old woman has a tonic-clonic seizure lasting 3 minutes.
This is her first seizure, which does not appear to have been
precipitated by an acute event. Serum electrolytes, an ECG and CT
head are normal. How long should the patient refrain from driving?
A. 3 months
B. 6 months
C. 12 months
D. 18 months
E. Ban from driving
DISEASE CAR LICENCE HGV LICENCE
First unprovoked 6 months if fit 5 years if risk of
seizure with a low rate free/medical review recurrence is <2% per
of recurrence annum
6 months during
treatment changes
Epilepsy 1 year if fit free / medical 10 years if fit free off
(2 or more seizures) review medication
Acute Coronary 1 month if untreated 6 weeks if symptom free
Syndrome and no inducible
1 week if treated with ischaemia on exercise
stent and normal LV tolerance test
Insulin-controlled Notify DVLA may drive if Banned
diabetes mellitus no visual impairment
and aware of
hypoglycaemia
Other ethical scenarios
HIV positive patient refusing to tell wife
Colleague smelling of alcohol
Duty of candour (they don’t know)
Complaints
Your Questions
Quick Tips:
Child (<18 years) can’t choose to die
All adults have capacity until proven otherwise
Adults (if competent) can refuse treatment or make unwise decisions
Sexual activity with a child under 13 is a criminal offence
Sections 2 +3 can only be implemented by healthcare professionals
Gifts - Don’t accept anything expensive!

End of Webinar
Thank you
GOOD LUCK!!!
Let us know how it goes!

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Ethics & Law

Autonomy ‘self‐rule’: Respecting and following the patient’s decisions in the

Beneficence: Promoting what is in the patient’s best interests.

Non‐maleficence: Avoiding harm.

Justice: Doing what is good for the population as a whole.

A. Transfuse blood against his will

A. Transfuse blood against his will

- Over 18 years old

- You must respect a competent patient’s decision to refuse an

Prohibit blood transfusions

Those who you must not transfuse in an emergency:

If not an absolute emergency:

A. Respect the patient’s wishes to withhold antibiotics

A. Respect the patient’s wishes to withhold antibiotics

- At 16 it is legally presumed that young people have the ability to

- However a minor may not choose to die (<18 years old)

A. Inform her parents

A. Inform her parents

● Understand the professional's advice

Children under the age of 16 can consent to medical treatment if they

A. Inform her parents

A. Inform her parents

- Sexual activity with a child under 13 is a criminal offence and

- Underage sexual activity should always be seen as a possible

A. Inform her parents

A. Inform her parents

- Sexual activity with a child under 16 is a crime

A. Inform her parents

A. Inform her parents

- Sexual activity with a child under 16 is a crime

- Anyone in a position of trust

A. Mental Capacity Act

A. Mental Capacity Act

Section 136: Police power to detain someone

● Used to take them to a place of safety

Section 4: Emergency admission to hospital order

• Applied by one doctor (usually a GP) and an approved social worker/relative

• Urgent necessity is demonstrable

• May be converted to a Section 2 or 3

Section 5 (2): Emergency doctors holding power

• Applied by any doctor on an inpatient to enable psychiatric assessment

• Good practice to convert this to a Section 2 or 3

Section 5 (4): Emergency (specialist) nurses holding power

Section 2: Admission for assessment order (from community)

• Applied by an Approved Mental Health Professional and two doctors

• May be converted to a Section 3 (section 2 can not be renewed)

• The patient has a right of appeal to a tribunal within 14 days of detention

Section 3: Admission for treatment order

• Applied on a patient already with a mental disorder (or under section 2)

• 6 months duration then reviewed

A. Respect her wishes and discharge her to her own home

A. Respect her wishes and discharge her to her own home

What is it to lack capacity?

What are the major principles of the mental capacity act?

How do we determine who has capacity?

Does a diagnosis of dementia affect your capacity?

If someone lacks capacity who makes the decisions?

What is it to lack capacity?

“A person lacks capacity in relation to a matter if, at the material time, he is

What are the major principles of the mental capacity act?

How do we determine who has capacity?

Capacity has four part: