In today’s micro lecture, we’re going to talk about assessing a patient’s mental capacity. If a person lacks capacity, then an appropriate person can take over that person’s decisions, if it’s in their best interest to do so.
In today’s micro lecture, we’re going to talk about assessing a patient’s mental capacity. For them to be able to make a decision as to what happens to them. Now let’s be clear, here. All of us as human being have a right to be able to decide what happens to us. Now, there is a caveat to that: under the mental capacity act, 2005, if a person lacks capacity, then an appropriate person can take over that person’s decisions all the while that they have a lack of mental capacity. If it’s in their best interest to do so.
The other side to this is, the moment the person’s mental capacity returns, you must give them back their decision making powers, even if the decisions the patient’s making does not line up with the decisions that you would make.
So, how do we assess mental capacity, then, and how does that leave us as paramedics, in terms of vulnerability? Well, let’s just put it this way, if we, as human beings had someone make decisions for us on a daily basis, that would be extremely difficult for us to operate and function as human beings. So we operate under those principles that we want people to be able to make their own decisions on a daily basis.
Now, there are some medical conditions that will immediately take away a patient’s mental capacity and ability to make safe and sound decisions. Such incidences include unconsciousness. When a person is unconscious you automatically do have informed, implied consent. You can treat that person until they gain consciousness and mental capacity. There are other medical emergencies, such as hypoglycemia, cardiac arrest, stroke. The list goes on.
So, as paramedics, how do we assess mental capacity? Number one, we have to try and establish that the patient can take in the information that we’re saying to them and telling them. Number two, they must be able to maintain and store that information. And number three, make decision.
For example, let’s say you arrive at a scene that somebody’s called you because they can’t breathe. When you get to the bottom of their history, they’ve had asthma in the past, and they’re having another asthma attack now; you go ahead and treat them with Salbutamol, you suggest that they come to hospital with you, because you’re not happy with their oxygen levels, but they say, “No, I don’t want to, I’ve got to go to work. I’m going to work, and there’s nothing you can do about it.”
So what I would do in that situation is say, “Okay, for me to safely leave you here, you need to understand that I am concerned about you because of your oxygen levels. I’m concerned that your asthma will come back the moment we leave, and if you can repeat back to me why we’re concerned, then that’s fine, you can go about your business. And if the patient’s able to say “Yes, I understand your concern about me, because my oxygen level’s low and chances are my asthma will come back. But I’m willing to take that risk.”
If the patient’s able to do that, it demonstrates that they’ve been able to take on board the information, retain it, and use it to make a decision that’s best for them. And that’s where your responsibility ends. Far too often, we’re concerned for our own jobs, rather than the patient’s ability to make their own decisions in life and we try to persuade them to come to hospital.
Now, persuading somebody to come to hospital is unethical, and immoral and we shouldn’t do it. We should always do what is best for the patient, and all the while the patient has their own capacity, that’s what’s best for the patient.
I hope you’ve enjoyed this micro lecture. I look forward to talking to you again shortly.