Articles for tag: assessment, capacity, consent, law, MCA, MHA, psychiatry, standards

A Tale of Two Capacities or is it One?

February 6, 2025February 4, 2025 by TheEditor

The differences between the conceptualisation of capacity under the Mental Health Act 1983 (MHA) and the Mental Capacity Act 2005 (MCA) in the UK are significant, particularly in their approaches to determining capacity for consent to treatment. The Mental Health Act 1983 (MHA) and the Mental Capacity Act 2005 (MCA) both address issues of capacity …

Intersection of Mental Health Act and Capacity Legislation

February 5, 2025October 22, 2024 by TheEditor

The case of Tees Esk and Wear Valleys NHS Trust v KAG [2024] EWCOP 38 (T3) and others offers a compelling illustration of the complexities that can arise at the intersection of mental health law and capacity law in the context of medical treatment decisions. This case involved the proposed insertion of a percutaneous endoscopic …

Bolam Test: Historical Context and Evolution

February 5, 2025April 2, 2024 by TheEditor

The Bolam test originates from the UK case Bolam v. Friern Hospital Management Committee [1957] 1 WLR 582. This legal precedent was set in a negligence case involving medical treatment, establishing a principle that would profoundly influence the standard of care in medical negligence cases not only in the UK but also in various jurisdictions …

Materiality

June 19, 2024December 9, 2023 by TheEditor

The case of Montgomery v Lanarkshire Health Board [2015] UKSC 11 is a landmark decision in the UK law of medical negligence, specifically in relation to the duty of a doctor towards a patient in relation to advice about treatment. It fundamentally altered the legal approach to patient consent and disclosure of risks by healthcare …

Polypharmacy

March 3, 2024May 29, 2023 by TheEditor

Polypharmacy is the use of multiple medications by a patient, particularly when too many forms of medication are used by a patient, when more medications are prescribed than are clinically warranted, or when all of an individual’s medications are not clinically necessary. While there is no set number of medications that defines polypharmacy, the term …

Off-label and off-licence prescribing

January 23, 2025May 3, 2023 by TheEditor

In the UK, the terms “off-label” and “off-licence” prescribing are often used interchangeably, but they refer to slightly different concepts. The General Medical Council uses the term ‘unlicenced prescribing’ to unify both. The terms do no mean or imply ‘illegal prescribing’. While the publisher and author(s) have used their best efforts in preparing information at …

Best interests and material risk

July 10, 2024June 6, 2021 by TheEditor

‘Best interests’ (BI) is a term used by average people who often make caring or ‘parental’ decisions about their children or loved ones. In medical practice the concept means a lot more, and its full meaning is wrapped in statute and common law precedent. This article will focus primarily on medically-related decision-making – and mainly …

What is consent?

January 23, 2025August 22, 2020 by TheEditor

This is an exploration of the concept of consent and its constituents. [This page is being updated continuously – last update: 2020-09-20.] While the publisher and author(s) have used their best efforts in preparing information at this website, they make no representation or warranties with respect to the accuracy, completeness or applicability of the contents …

Prescribing and related regulatory matters

July 10, 2024August 6, 2020 by TheEditor

The GMC’s standards on prescribing were updated in March 2022. This publication will have less weight and applicability. This article is intended to be of assistance: To medical doctors and other qualified persons undertaking or participating in medication reviews. To other staff who may be assisting doctors with arrangements for medication reviews. In understanding …

Stage	Cost/Price (£)	Tax/Duty (£)	Tax/Duty Type	Calculation	Calculation
1. Manufacturer’s Cost	2	0	N/A	This is a hypothetical cost of production.
2. Specific Duty Added	2	5.89	Specific Duty	£294.72 per 1000 cigarettes / 1000 * 20	Fixed amount per pack.
3. Manufacturer’s Profit	7.89	0	N/A	(Assumed to bring the total to £7.89)	This is a hypothetical profit margin.
4. Ad Valorem Duty Included	9	1.11	Ad Valorem Duty	16.5% of £9.00 (approx. retail price before VAT)	Included within the retail price, not added separately.
5. Retailer’s Profit	10.11	0	N/A	(Assumed to bring the total to £10.11)	This is a hypothetical profit margin.
6. Final Retail Price (excl VAT)	13	0	N/A	(Includes specific duty and ad valorem duty)	This is the price displayed on the shelf, excluding VAT.
7. VAT Added	13	2.6	Value Added Tax (VAT)	20% of £13.00	Applied at the point of sale.
Total	15.6	9.6	Approximately 61.5% of the final price (£15.60) is tax – due to the simplified conservative assumptions about manufacturer and retailer costs and profit margins.

Documentation Issue	Critique
Vague Descriptors	Terms like “distressed state,” “emptiness,” and “intense anger” lack specific behavioural anchors. The descriptions are mere observations without any real substance. How was the intensity of the anger manifested? What did the patient say? How did she appear? Was she grimacing? Without concrete examples, these descriptors are open to interpretation and do not provide a clear picture of the patient’s presentation.
Generalised Interventions	Phrases like “explored coping mechanisms” and “discussed strategies” are so general that they amount to padding. No one will know what specific coping mechanisms were explored. How did this worker actually attempt to help the patient? What exact strategies were discussed? How were these tailored to the patient’s individual needs and the nature of their emotional instability?
Lack of Measurable Outcomes	The record mentions the patient feeling “slightly calmer” but lacks objective measures to assess the effectiveness of the interventions. How was this improvement gauged? Is it just ‘your’ word for saying so? Many services will accept such records as ‘standard’ because of cultural norms.
Ambiguous Plan	The plan to “continue to work on developing skills” and “encourage the patient to practice techniques” is vague and lacks specific, measurable goals. What specific skills will be targeted? What techniques were discussed ‘between sessions’? How will progress be monitored? What constitutes “practice” in this context, and how will adherence be assessed?
Omission of Risk Assessment	Given the nature of EUPD and the potential for self-harm, the record should include a formal risk assessment. What specific risk factors were considered? How was the risk of self-harm evaluated and managed?
Limited Patient-Specific Insight	While the record mentions EUPD, it does not provide specific insights into how this diagnosis informs the interventions or the plan. How were the chosen strategies tailored to the patient’s unique challenges related to their personality disorder?

Cognitive Activity	Description
1. Information synthesis	Gathering and integrating diverse information; evaluating reliability and relevance of each piece
2. Evidence evaluation	Critically assessing quality and strength of available evidence; identifying gaps
3. Principle balancing	Weighing competing ethical principles; reconciling guidelines with case-specific considerations
4. Stakeholder consideration	Analysing individual patient needs/rights; considering regulatory and societal requirements
5. Consequence projection	Anticipating potential outcomes; assessing short-term and long-term consequences
6. Risk-benefit analysis	Systematically evaluating risks; weighing risks against potential benefits
7. Legal framework integration	Incorporating relevant legal standards; ensuring compliance with statutory obligations
8. Ethical reasoning	Applying ethical frameworks; resolving ethical dilemmas in forensic psychiatric practice
9. Interdisciplinary integration	Synthesising perspectives from various disciplines; reconciling conflicting viewpoints
10. Decision refinement	Iteratively reviewing and adjusting decisions; fine-tuning to address all relevant factors
11. Uncertainty management	Acknowledging areas of uncertainty; developing mitigation strategies
12. Prioritisation	Determining relative importance of factors; focusing on critical elements
13. Cognitive bias recognition	Identifying potential biases; implementing strategies to minimise their impact
14. Justification formulation	Developing clear, logical rationale; ensuring transparent and defensible reasoning
15. Contextual adaptation	Tailoring approach to specific case factors; recognising unique case influences

Beyond Cheshire West: A Triangular Framework for Decision Making

Cheshire West: What’s to be learned?

Section 136: A Framework in Crisis

Articles for tag: assessment, capacity, consent, law, MCA, MHA, psychiatry, standards

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