Overview of the Assisted Decision-Making (Capacity) Act (2015)

Ruth Usher,Tadhg Stapleton

doi:10.1108/ijot-08-2018-0013

Ruth Usher, Tadhg Stapleton

Open Access

https://doi.org/10.1108/ijot-08-2018-0013

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Abstract

PurposeIn Ireland, the Assisted Decision Making (Capacity) Act 2015 provides a statutory framework to adults who are experiencing difficulties with decision-making. This legislation has significant implications for all who work in health and social care. Increasing age and life expectancy, alongside the rising incidence of chronic health conditions and dementia-related diseases, indicates that more individuals are likely to experience challenges regarding decision-making capacity. Therefore, the need for more consistent, best-practice processes to assess decision-making capacity is likely to increase. To ensure occupational therapists are responsible in their contributions, and to ensure those with disabilities are supported, clinicians must be well-informed of the principles underscoring the Act. The purpose of this paper is to provide an overview of this multidisciplinary issue, including recent legislation, and consider how occupational therapy can contribute.Design/methodology/approachThe authors reviewed current literature and considered occupational therapy’s role in decision-making capacity assessment.FindingsOccupational therapists have potential to play a key role in multi-disciplinary assessments of decision-making capacity for clients. Further research is required to explore professional issues, identify clinical best practices and determine training and resource needs.Originality/valueThis paper seeks to provoke consideration of how occupational therapists can contribute to capacity assessment from a client-centred, occupation-based perspective that is mindful of ethical and legislative considerations.

Highlights

In most democratic countries, there is a basic assumption that adults have the right and capacity to make decisions around issues affecting their lives, such as where to live, social engagement choices, personal care preferences, financial decisions and healthcare decisions, based on the premise that adults have adequate understanding, appreciation, reasoning and choice (Wong et al, 1999; Charland, 2015)
healthcare and social care professionals (HSCPs) have an ethical duty to ensure that judgements of capacity are unbiased and accurate (McCormick et al, 2017)
Research is required to investigate current occupational therapy practice in Ireland, to explore professional issues and to identify training and resource needs for professionals involved in capacity assessment

Summary

Introduction

There is a basic assumption that adults have the right and capacity to make decisions around issues affecting their lives, such as where to live, social engagement choices, personal care preferences, financial decisions and healthcare decisions, based on the premise that adults have adequate understanding, appreciation, reasoning and choice (Wong et al, 1999; Charland, 2015). All healthcare and social care professionals (HSCPs), including occupational therapists, are ethically and legally obliged to be aware of new developments and legislation regarding DMC, when working with clients with cognitive disability, such as those with intellectual disabilities, mental health difficulties or neurodegenerative conditions, such as dementia. Ratcliff and Chapman (2016) observed that in the UK, comprehensive training around their capacity legislation did not necessarily lead to high-quality application of requirements in practice, due to knowledge gaps among HSCPs. it is imperative for occupational therapists to be aware of the Act, to understand issues related to DMC assessment and to consider our potential role in contributing to this process (Figure 1). HSCPs must develop understanding of their roles, to ensure that individuals are given the support and accommodations that they require to maximise their participation in decision-making about their lives. While many different assessment methods are used by occupational therapists, no guidelines exist regarding the most thorough way to approach these DMC assessments to ensure client-centred, occupation-based practice

Current issues

Conclusion