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Hi, everyone. Thank you for joining. I'm just gonna give it a few minutes to let more people join, but we'll start around two or three past six. Ok. I'm going to very slowly make a start. I hope you're all doing well. Welcome to our teaching session on ethics and law. This is like pretty much guaranteed that it comes up in ay every single year. So if there's anyone else that you wanna invite for that, um please bring them along. So I'm sure you're used to the drill by now by teaching things. Um We do weekly tutorials on Thursdays which are focused on core presentations and oy practice and please subscribe followers. Ok. So in this first topic, um I'm Eleanor, we're going to be covering capacity, advanced care planning, which is inclusive of an advanced directive and advanced statements and also the subsection of this, which is DNA CPL. Ok. So this tutorial is gonna follow the case of Mavis who is a 74 year old lady recently diagnosed with metastatic breast cancer. She's come to terms with the news and expressed a wish to opt for symptom management only. She has no other medical history of note and she lives independently. So my first question, which I'm going to put a poll up for is which one of these statements is the best answer regarding her capacity to refuse treatment. The answers are quite long. So I'll give you guys some time to read them. Yeah. Ok. We've got some responses through. We seem to be very split between them actually. Yeah. Ok. Ok. Ok. I'm gonna go on to the answer. The correct answer is actually option C um she can refuse treatment with no capacity assessment. Well, there's no reason to suggest capacity assessment. We'll go into this in a bit more detail, but this is the correct answer because every adult in the UK is assumed to have capacity unless there's a reason to think so. And the stem specifically said that she has no other medical conditions. If there was a history of dementia or some kind of cognitive impairment, then yes, 100% an assessment should be done, but a is wrong because it doesn't matter what kind of treatment it is, she has a right to refuse. Um She's within her rights to refuse treatment but needs to have a capacity assessment due to her age in itself, age doesn't warrant a capacity ass obviously, it can increase the chance of you having cognitive impairment, but in itself not a reason she should discuss with her family. Um as you know, her baseline capacity, best family is always involved in the decision. But ultimately, it's up to the patient and the final option, treatment can never be um sorry, treatment can not ever be requested, it can only be refused. So yes, that is wrong. So the capacity rules in adults, the key thing that you should always start your Ruskies with is by saying that everyone is assumed to have capacity unless there's a reason to think otherwise. And when we actually assess capacity, we go down these four key principles and with the example of this patient. So number one, can they understand what the treatment is and what it will do? Number two, can they retain the information that the doctor or healthcare professional has communicated about the treatment? Can they weigh up the pros and cons of the treatment and finally can they communicate effectively their final decision? So Mavis's wishes are respected by the team and she now wants to start advanced care planning, which of the following would be a part of her advanced decision. Paul going on. Mhm Yes. Ok. I OK. The most common one seems to be option C which is correct. Um We'll go through advanced directives in a little bit on the conditions that need to be fulfilled for them. But a is wrong because anything that's designed purely for comfort such as painkillers cannot be refused. Um Neither can basic care like being washed, being showered, being fed. Um Same and d specifically like preferences for things would go in advance statement, which we will also cover later. And finally, you also cannot use it to refuse treatment for any mental health conditions you've been sectioned for. So an advanced directive makes up part of an advanced care plan. The full form of it is advanced directive to refuse treatment. And there's two key factors to it. It's a legally binding document which ensures individuals can refuse specific treatments in the future when they lack capacity. So going into each of those key points in a little bit more detail, for it to be legally binding, the advanced directive needs to fulfill some criteria. So it needs to have been made when the individual had the capacity and was over 18. It needs to be specific to the situation. So in this instance, refusing antibiotics for a chest infection would be the specific um scenario not have been coerced by other people when making the decision and it also needs to be signed and witnessed. So for the first part, for it to be legally binding, these conditions need to have been met. Then when we talk about specific treatments, it can be it's for life sustaining treatments that can be refused but not for things like basic care like washing food or drink by mouth. Um measures for comfort, like pain meds or mental health conditions that someone was sectioned for and just in general in anything to do with medicine, treatment can never be requested. It can only be refused.