NICE issues draft guidance on decision-making and mental capacity

NICE has published new draft guidance that provides advice to health and social care professionals on the complex issue of decision-making and mental capacity in adults.

The guidance is relevant to people over the age of 16 years who may lack the mental capacity to make specific decisions about their care, including consenting to medical treatment, either currently or in the future. It aims to help health and social care professionals support people who still have the capacity to make their own decisions, and keep patients who lack capacity at the centre of the decision-making process. A person may lack mental capacity as a result of an illness or condition such as dementia or a brain injury.

The guideline was commissioned by the Department of Health in response to concerns raised by the Care Quality Commission, who had identified serious issues with the implementation of the Mental Capacity Act 2005 within health and social care in England.

The draft guidance emphasises that people have the right to be involved in discussions and making informed decisions about their care. They should be provided with support so that they can take part in decision-making, allowing them time to communicate their needs and feel listened to, with the involvement of family, friends and carers.

Mental capacity should be assessed in line with the processes set out in section 3 of the Mental Capacity Act. Health and social care professionals should not assume that the person lacks capacity because they have made a decision that is perceived as risky or unwise, or if they are judged to lack insight into their condition. However, if the person is assessed as lacking mental capacity to make a specific decision, professionals should ensure that the person’s best interests are met when making decisions on their behalf, taking into consideration their wishes, values and beliefs.

Advance care planning, in which a person’s wishes and preferences are discussed and set out in advance for a time when they may lack mental capacity to make treatment decisions for themselves, should be offered to people with long-term or life-limiting conditions.

Nageena Khalique QC, vice chair of the guideline committee, said: “Our draft guidance will help empower and support people who do have capacity to overcome difficulties they may face when making decisions. They should be provided with the right information to support that specific decision. Health and social care professionals should also make sure families, friends and carers are involved in these discussions.” She added: “If someone is assessed as lacking capacity to make a decision, we must do everything to keep them involved in the process and take into account their wishes and feelings. They should be at the heart of decisions made on their behalf.”

The draft guidance is currently in consultation with final guidance expected in May.


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