QuestionSBA
QuestionChoice
This is best answer. The Mental Capacity Act (2005) states that all patients should be assumed to have capacity unless proven otherwise (Principle 1). Therefore, it is important to assess this patient's capacity, even though you know their condition and previous MMSE scores make it unlikely that they do have capacity. If an individual does not have capacity for a particular decision then the doctor must make a decision that both, acts in the patient's best interests (Principle 4), and is the least restrictive option (Principle 5). In this case, the information in the stem suggests that having the vaccination would be in the patient's best interests: he is at risk, and there is no evidence that it would have been against his wishes when he did have capacity
32898
a
Assess whether the patient has capacity for this decision. If the patient does not have capacity, then give the flu vaccination because it is in the patient's best interests
QuestionChoice
The first part of this choice is correct: the patient's capacity should be assessed in keeping with Principle 1 of the Mental Capacity Act (2005). However, there is nothing in the stem to suggest that giving the patient the flu jab would be against their best interests
32900
c
Assess whether the patient has capacity for this decision. If the patient does not have capacity, then do not give the flu vaccination because it is not in the patient's best interests
QuestionChoice
The first part of this choice is correct: the patient's capacity should be assessed in keeping with Principle 1 of the Mental Capacity Act (2005). However, if there is no advanced directive then the doctor will have to act in the patient's best interests (Principle 4). An advanced directive is a helpful tool for a patient to create (when they have capacity). Not having one though, should not preclude treatment if they are deemed not to have capacity
32901
d
Assess whether the patient has capacity for this decision. If the patient does not have capacity, then do not give the flu vaccination because the patient does not have an advanced directive
QuestionChoice
The first part of this choice is correct: the patient's capacity should be assessed in keeping with Principle 1 of the Mental Capacity Act (2005). However, if the patient does not have capacity, the GP should think about what is in the patient's best interests (Principle 4). In this case, that is done by giving the vaccination
32899
b
Assess whether the patient has capacity for this decision. If the patient does not have capacity, then the GP cannot give the flu vaccination
QuestionChoice
This is incorrect. The patient's capacity needs to be assessed before making a decision here. The presence of a DNAR form only means that, in the event of a cardiac arrest, the patient should not have cardiopulmonary resuscitation. It does not mean the patient cannot have other treatments. This is a common misconception amongst patients
32902
e
Do not assess whether the patient has capacity for this decision because they have a DNAR. Do not give the vaccination because the patient has a DNAR
QuestionComment
cant really assume that the vaccine is his best interest? 
62125
User
subscriber
Hypertension Kinase
Concept
Chapter
# What are Best Interests? 

If someone lacks capacity to make a specific decision, a decision may have to be made in their _best interests_. This means that a decision will be made on their behalf, having been considered from their point of view. The decision should be one that health and social care professionals believe is the right decision for _that individual patient themselves_ (and not the decision that the professionals desire without taking the patients interests into account).

# Best Interests Criteria

When making a best interests decision on behalf of someone who lacks capacity, five factors must be considered:

1. Equal consideration and non-discrimination
2. All relevant circumstances
3. Regaining Capcity
4. Participation
5. Wishes, Feelings, Beliefs and Values

# What are Equal Consideration and Non-discrimination? 

The person making the decision about what is in the patient's best interests must not make assumptions based on _age, appearance, condition or behaviour_.

# What are All Relevant Circumstances? 

In order to determine what is in the patient's best interests, all the things that the patient would take into account if they were making the decision themselves should be identified .

# Regaining Capacity 

It must be considered whether the patient is likely to regain capacity. If so, the professional(s) need to consider whether or not the decision can be delayed until then.

# Participation 

All practicable steps should be taken in order to encourage and enable participation by the patient in the decision making process.

# Wishes, Feelings, Beliefs and Values 

The wishes, feelings, beliefs and values of the patient should be found out and taken into consideration. This includes views they have expressed in the past, religious or moral opinions, or other factors that might influence the decision they would make themselves.
2033
584
Best interest decisions in patients who lack capacity
Topic
30
Ethics and Law
6580
Assessing a patient's capacity is essential before making healthcare decisions, particularly for those with cognitive impairments like dementia.
A 75-year-old male patient is brought into his GP practice by his wife. He had received an invitation by the practice to come in for his annual flu vaccination. He has a history of Parkinson's dementia, type 2 diabetes mellitus and obesity. He requires carers four times a day, and on his last visit to the GP he scored 5 out of 30 on an MMSE (mini-mental state examination). He has a Do Not Attempt Resuscitation (DNAR) form but does not have an advanced directive.

His wife asks the GP whether he can have his flu vaccination, which of the following is the best next step?
a