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Mental Capacity Act practice guidance

Part 4

How MCA helps people plan for the future

Code of Practice chapter 7 and chapter 9

No-one knows when they might lose capacity. Anyone may lose capacity through illness or injury and some people may know that they have a condition which will lead to a loss of capacity.

The Mental Capacity Act (MCA) enables everyone to lay out their wishes for a time when they lack capacity, by making Advance Decisions, Advance Statements or donating a Lasting Power of Attorney (LPA) (Part 17: Advance Decisions and Advance Statements) (Part 19: Lasting Powers of Attorney)

If someone is in the early stages of a deteriorating illness it is good practice for them to be advised to make plans for their future.

If someone doesn’t have capacity to make decisions about who they would like to make decisions for them, then that person can’t make any Advance Decisions or nominate an LPA. If they have a considerable amount of money or property it is appropriate for an application to be made for the Court of Protection to appoint a deputy to manage their financial affairs for them. (Part 26: People who lack capacity to manage their money)

The Court of Protection has the power to appoint a Welfare Deputy to make decisions about someone’s health and welfare. Such appointments are rare: it is more common for decisions to be made using the best interests process, as each decision arises. (Part 8: Best interests decisions) (Part 23: The Court of Protection)

It is vital that everyone is helped to make plans as they approach the end of life.

If someone has capacity, they should be advised to consider making Advance Decisions, including decisions about whether they would wish resuscitation to be attempted if they have a cardiac arrest.

A Treatment Escalation Plan should be considered if someone has complex needs and there may be disagreement about what medical treatment they should be given. This is completed by the medic in charge of their care, in consultation with family or friends and others who know the person and considers what is known about their past and present wishes. (Part 18: End of life care and decision-making)