Planning ahead

How can I plan ahead with the Mental Capacity Act?

There are three key ways which you might want to use in order to plan for a time when you may lack capacity.

Lasting power of attorney

The Mental Capacity Act enables you (if you are over 18 and have the capacity to do so) to appoint someone to make decisions about your personal welfare (health/social care etc.) or property and affairs (finances etc.) should you ever lack the capacity to make these decisions yourself. This is called a lasting power of attorney (LPA). You are known as the donor. The person or persons you appoint are known as the donee.

See the GOV.UK website for more information about lasting power of attorney.

Advance decisions to refuse treatment (ADRT)

You can also make a decision in advance to refuse (not request) particular medical treatment. This decision would become especially relevant should you lack capacity to refuse such treatment in the future. You must be over 18 when you make your advance decision. It must be valid and applicable. Your intentions concerning the treatment that you want to refuse and the circumstances of refusal must be clear. Other than for decisions about life sustaining treatment (such as resuscitation in the event of a heart attack) advance decisions need not be in writing. Refusals of life sustaining treatment are governed by strict rules in the Act. For more information click here and view chapter 9 of the Mental Capacity Act Code of Practice.

You can refuse mental disorder treatment by way of an advance decision, but if you were to be detained under the Mental Health Act, the decision about the mental health treatment may need to be overridden under the provisions of that Act, though that is not always the case. Even if you are detained under the Mental Health Act, refusal of treatment relating to an unrelated physical condition might still be upheld as long as it is valid and applicable to the treatment in question. There are also rules relating to the refusal of electroconvulsive therapy which in some circumstances enable refusal even when detained under the Mental Health Act.

You might wish to discuss the making of an advance decision to refuse treatment with your doctor or other health professional. You may benefit from the advice that you receive, but you do not have to ask anyone's permission to make an advance decision to refuse treatment.

Advance statements

An advance statement (or statement of wishes and feelings) is about anything else other than refusal of specific medical treatment. For example, you could request a treatment that has worked well for you in the past. An advance statement is simply anything that you may have said or written down concerning your care and or treatment.

If you are over 16, you might wish to write down your wishes and preferences about care or other aspects of your life that you want clinicians to be aware of when they are looking after you and you may not be able to tell them yourself.

The Trust has forms that you could use (available to download below) – although you are not legally required to use these or any forms if you don't want to. The booklets do give a helpful reminder of things that you can put in your advance statement. Should you lack capacity to make a decision for yourself, a decision maker is required to take this statement into account when considering your best interests.

You should note that an advance statement not legally binding, but a decision maker should give reasons why it was not possible to carry out your requests.