The guiding principles of the Act require healthcare workers to do the following:
- Presume every person has the capacity to make decisions about their life
- Support people as much as possible to make their own decisions
- Don’t assume a person lacks capacity just because they are making, have made or are likely to make what a healthcare worker, or another person, might perceive to be an 'unwise' decision
- Only take action where it is really necessary
- Any action should be the least restriction on a person’s rights and freedoms
- Give effect to the person’s will and preferences
- Consider the views of other people
- Consider how urgent the action is
- Use information appropriately
Interaction with decision supporters
Healthcare workers will be required to engage with a person’s legally appointed decision supporter under the 2015 Act. Healthcare workers may also be required to check the the Decision Support Service’s decision arrangement register to see if a person has a decision supporter and/or to check that the decision supporter is working within the scope of the agreement.
All practicable steps to support decision-making
If a person needs to make a decision in relation to their care or treatment, they must be supported to make that decision, e.g. through the provision of accessible information. This will mean that health and social care consultations may take more time.
Functional assessment of decision-making capacity
The functional assessment of capacity will now have a statutory basis and should be used in place of status based capacity assessments for the assessment of decision-making capacity. Healthcare professionals and registered medical practitioners may be required to undertake assessments of capacity to assess whether a person can make decisions with the support of a co-decision-maker or has the capacity to make an Enduring Power of Attorney.
Questioning a person’s capacity should be a last resort and only after all efforts have been made to support the person in their decision-making. Just because a person requires a capacity assessment regarding one decision does not mean that all other decisions also need capacity assessments. Each person has a right to be supported in decision-making for each individual decision at different times.
Advance Healthcare Directives
The purpose of an advance healthcare directive is to provide healthcare workers with important information about a person’s refusal of healthcare treatment and to enable a person to be treated according to his or her own ‘will and preferences’ even when he or she no longer has the capacity to make decisions.