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Mental Capacity Act (MCA) practice guidance


Part 18 End of life care and decision-making

It is wise for everyone to make sure people around them know what sort of care they would like at the end of their lives. However people’s needs change and capacity can change as people become weak and frail.

It is sensible for everyone who has capacity to do so to make Advance Statements about medical care they wish to refuse. (Part 17: Advance Decisions and Advance Statements)

Do Not Attempt Resuscitation orders (DNARs)

These orders relate to a decision made in advance as to whether someone should be resuscitated in the event of a cardiac arrest.

If someone has capacity to make this decision they should make it for themselves and their wishes must be respected. If there may be doubts about their capacity it may be wise to record that they have capacity to make this decision. (Part 17: Advance Decisions and Advance Statements)

 Treatment Escalation Plans (TEPS)

  • A TEP is a clinical document giving guidance to health care professionals about which treatments an individual should or shouldn’t be given. It is designed to simplify decision-making when people have complex needs and is often used when people are approaching the end of life.
  • A TEP form should be completed together with an indication of the person’s capacity to make decisions about their medical care.
  • A TEP is completed by a doctor and gives guidance as to whether the person should or shouldn’t be given different types of treatment. Separate guidance will be given about separate types of treatment. A TEP form may say that someone should not be given any particular type of treatment.
  • A TEP form is completed in consultation with the person and their family, as far as is possible and appropriate.
  • The decisions about treatment made on a TEP form are made by the doctor and not by family.
  • A TEP form should travel with the patient wherever they go.
  • Social care professionals should immediately make a TEP form available to a healthcare professional who attends to administer treatment to the patient.
  • A TEP form needs to be regularly reviewed and updated in response to any change in the person’s condition, any change in their views or that of their family or any views of people caring for the person.
  • In the event of a medical emergency where the evidence (of Advance Decisions or a TEP form) is not clear, someone should be given first aid and contact made with emergency services. If the documentation is not clear, medical treatment will be given.
  • Anyone caring for or supporting someone who is near the end of their life should ensure that all documentation is clear and readily accessible to all staff and medics. Everyone should advocate for the individual and what is known about their wishes.

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