Capacity And Consent Case Study

Introduction:
Prescription and administration of medicines is a key element of client care. Prescription drug use has increased hugely in recent years. Every day 7,000 doses of medication are administered in a typical NHS hospital (Audit Commission 2002). In 1993, 1.9 billion prescriptions were written and in 2001 the number had risen to 3.1 billion cited by Crigger and Holcomb (2008). Prescribers are bound by law and by the demands of good practice to consider the extent to which a person can make decisions regarding taking medications for themselves. The study of adult clients with intellectual disabilities is no exception. Although as adults they are legally eligible to consent or not to consent to their own treatment, persons with intellectual
The main legal issues that surround decision making for persons with intellectual disabilities are of capacity and consent. Every adult is presumed to have the capacity, but it is a presumption that can be rebutted. Once persons have reached adult age it is assumed in law that they are capable of making decisions. However, if a person has some form of intellectual disability and it can be demonstrated that they are not capable then different rules apply. Here a person must be able to understand the nature of the action and its consequences to be able to take a legal decision. Capacity is determined by a test of understanding not wisdom, Law Commission (1995). A person lacks capacity if some impairment or disturbance of mental functioning, such as intellectual disability or dementia renders the person unable to make a decision whether to consent to or refuse treatment, then the law allows medicines to be given in the absence of a valid consent in the person’s best interest (House of Lords,
The Department of Health & Welsh Office (1999) states that “treatment for those who lack capacity may be prescribed in their best interests under the common law doctrine of necessity and thus necessary to save life or prevent deterioration or ensure an improvement in the patient's physical or mental health”. Chua et al (2001) finds further justification for the non-consensual administration of treatment by enshrining the principle that adults who are unable to fully understand the nature and effect of medical intervention should not be deprived of treatment. Kellet, Griffith, Bell, Short and Adshead (1996) raise other discussion over the covert treatment of a patient who actually accepted that it helped him, but which resulted in an enquiry committee against the prescribing psychiatrist and suspension of the nurse, in spite of the fact that the treatment was not found to be unethical. Welsh and Deahl (2002) ask that instead of a confusing debate, should professionals look at deontological principles? Do we need to look at the rightness or wrongness of covert administration of medicine, they