QuestionSBA
QuestionChoice
It would be inappropriate for a family member to break bad news, especially without an appropriate clinician present to ensure accurate information sharing. It is also doubtful whether the daughter would tell the patient at all.
62155
c
Agree to let the daughter tell the patient once she has recovered and is at home in her own environment
QuestionChoice
LPA is only applicable in patients who have lost capacity. Therefore the patient currently has full power to decide regarding her care, provided she has capacity to do so.
62156
d
You cannot disclose, as the daughter has Legal Power of Attorney and therefore has the right to decide on the patient's behalf
QuestionChoice
You must assess capacity before deciding whether to follow or override the daughter's wishes. Secondly, even if there is capacity the patient herself has 'the right not to know'- ask first.
62154
b
Tell the patient everything
QuestionChoice
LPA is only applicable in patients who have lost capacity. Therefore the capacitous patient can currently override the daughter's wishes. If the patient does/does not want to know, that is her decision to make.
62153
a
Assess capacity: if the patient has capacity, tell her whatever she would like to know
QuestionChoice
A best interests meeting would not be appropriate if the patient has capacity to make her own decisions.
62157
e
Call a Best Interests Meeting, with other healthcare professionals and Next of Kin
QuestionComment
I thought we should believe the patient has capacity unless proven otherwise.
29305
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# Overview

Built into the Mental Capacity Act (2005) are provisions designed to aid decision making on behalf of vulnerable individuals who lack capacity. Three of them are making a Lasting Power of Attorney, Independent Mental Capacity Advocates, and the Court of Protection. Each have different roles but all aim to ensure that all decisions made on behalf of an individual are in their best interests.

# Lasting Power of Attorney (LPA) 

If an individual wants to legally appoint someone they trust to make decisions on their behalf in the future if they lose capacity, they can do this by making a lasting power of attorney (LPA). Usually an individual chooses a close relative or friend to be their "attorney", who is given legal power to make decisions about their health and care if they lose capacity at some point in the future.

An individual's attorney can make decisions about health and care decisions, including:

_Where an individual should live, what care or treatment they should receive, decisions about their daily routine (food, activities, etc.). If special permission has been given, an attorney can also make decisions about life-saving treatment._

# Independent Mental Capacity Advocates (IMCAs) 

IMCAs are used when an individual lacks the capacity to make a specific important decision, when there is no-one independent of services (e.g. a family member or friend) appropriate to represent the individual lacking capacity.

IMCAs support and represent the individual who lacks capacity, ensuring the Mental Capacity Act, 2005 is followed.

# Court of Protection 

The Court of Protection is a court that if applied to, can make decisions about an individual's health, welfare, finances and property under the Mental Capacity Act 2005.

The types of decisions the court can rule on include:
_Whether an individual has capacity to make a decision, whether a decision is in an individual's best interests, removing an attorney under a lasting power of attorney._

The Court of Protection always makes decisions in an individual's best interests.
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Lasting power of attorney, IMCA, and Court of Protection
Topic
30
Ethics and Law
12492
A 92 year old female is admitted after feeling generally unwell, with a one day history of left iliac fossa pain and bloody diarrhoea. A computed topography (CT) scan of her abdomen shows evidence of acute diverticulitis. However, it also shows a thickening of the ascending colon which is highly suspicious for malignancy.

The patient's daughter has Lasting Power of Attorney (LPA). She believes it is not in the patient's best interests to be told about the possible cancer diagnosis as it would cause too much distress. She asks you not to reveal the full scan result to the patient.
The patient had shown evidence of capacity at the time of your initial review.

Which of the following would be the most appropriate next course of action?
a