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Advance Decisions Policy

Aim

The aim of this policy is to ensure that Cavendish Homecare Professionals fully implement the Mental Capacity Act 2005 which includes provision for clients to make advance decisions.

Implementation

Cavendish Homecare Professionals fully supports the implementation of the Mental Capacity Act and its associated Code of Practice, including guidance on advance decisions and advance statements.

In this organisation:

  • Individuals are entitled to decide whether they want to specify treatment choices and refuse treatment in advance by completing an advance decision but there is no obligation for them to do so and no pressure should be brought on them to complete such a decision.
  • Advance decisions will be respected and followed by care staff as legal indications of a service user’s preferences provided they are both valid and applicable.
  • Advance decisions can be verbal if there is sufficient evidence that they are valid and where they do not relate to ‘life sustaining’ treatment. However, in general it is always best for a person wishing to make an advance decision to do so in writing and to have the decision communicated to their families, carers, advocates, legal representatives, care teams and to their GP. An explicit written decision helps to avoid any doubt.
  • If an advance decision involves refusing ‘life-sustaining’ treatment then it must be put in writing and signed by the maker in the presence of a witness who must also sign it.
  • Staff must make reasonable efforts to confirm the existence of an advance decision.
  • Where no advance decision or ‘living will’ has been made, then in cases where the person loses mental capacity, due to illness or because they are near death, decisions will be made for them in their best interests by the doctors and professionals involved in their care in consultation with family, friends, carers and representatives to understand the wishes of the client.
  • Under the Mental Capacity Act, care professionals will be protected from liability if they:
    • stop or withhold treatment because they reasonably believe that an advance decision exists that it is valid and applicable
    • treat a person because, having taken all practical and appropriate steps to find out if the person has made an advance decision to refuse treatment, they do not know or are not satisfied that a valid and applicable advance decision exists
  • According to the Mental Capacity Act 2005 to be valid the individual who made it must have fully understood the implications. A valid advance decision needs to:
    • be made by a person who is 18 or over and has the capacity to make it
    • specify the treatment to be refused (it can do this in lay terms)
    • specify the circumstances in which this refusal would apply
    • not have been made under the influence or harassment of anyone else
    • not have been modified verbally or in writing since it was made.
    • An advance decision becomes invalid if withdrawn by the individual who made it.
  • According to the Mental Capacity Act 2005 to be applicable an advance decision needs to:
    • clearly refer to the treatment in question
    • be unambiguous
    • explain which circumstances the refusal refers to
  • Any treatments that are being refused must all be named in the advance decision recognising that a client may want to refuse a treatment in some situations but not others. These must be specified.
  • An advance decision cannot be used by someone to ask for their life to be ended, to refuse basic care – such as washing or bathing, or food and drink offered by mouth, or essential pain relief. It also cannot be used to demand specific treatments or to ask for anything that is illegal.
  • If the status of the advance decision is less clear, then to establish whether it is valid and applicable, care staff must try to find out if the person:
    • has done anything that clearly goes against their advance decision
    • has withdrawn their decision
    • has subsequently conferred the power to make that decision on an attorney, or
    • would have changed their decision if they had known more about their current circumstances or current options, ie. advance decisions may sometimes refer to older treatments which have been replaced by new drugs or treatments which may have been acceptable.
  • Clients should be referred to their GP, to their legal representative or to an independent advocate if they express the wish to write an advance decision but need help and advice about their treatments and about ensuring that the decision is valid.

Training

In this organisation all care staff should be trained in the basic principles of the Mental Capacity Act and in its direct application to their work, including advance decisions and advance statements.

 

 

Date: January 2024

Version 8 (Reviewed)

Source: Expert Care Manager