Intensive Care Consultants and their obligation from the Assisted Decision Making (Capacity) Act 2015

Abstract

Aims
The purpose of this paper was to explore the level of knowledge and preparedness that Intensive Care Consultants have of their obligations under the Assisted Decision Making (Capacity) Act 2015 as it pertained to patients requiring decisions to be made on their behalf within the Intensive Care Environment.

Methods
The 2015 Act was reviewed and a questionnaire was developed assessing key provisions of the Act necessary for lawful decision making. The questions were formatted with binary responses to confirm that respondents were operating within the meaning of the law; subject to the legal principle of ignorantia legis neminem excusat. This questionnaire was circulated amongst Intensive Care Consultants working in Model 4 Hospitals approved for Joint Facility of Intensive Care training. A third-party online survey platform was used to anonymously collect and process responses from those who consented to participate. Qualitative analysis of the responses was performed.

Results
22/63 (35%) ICU physicians completed the questionnaire. 19/22 (86%) were aware of the introduction of the 2015 Act. 14/22 (64%) were able to identify a “relevant person” under the meaning of the Act. 9/22 (41%) had received training in relation to the act. 7/22 (32%) of respondents were aware of the scope of decisions covered by the Act. 6/22 (27%) were aware of the legal obligations placed upon them by the Act. When challenged, 0/6 (0%) of those were able to successfully identify all statutory criteria for decision making capacity. 5/22 (26%) of respondents stated they had changed their approach to patient decision making since the introduction of the Act.

Discussion
Deficits in preparedness, knowledge of and familiarity with the Act were evident amongst all respondents. The legislation does not allow for physician interpretation and requires full compliance at all times. Training was either not provided to or not sought out by the majority of respondents. Of those who reported that they were aware of their obligation no one was able to fully demonstrate the minimum expected statutory criteria for decision making capacity. Failure to comply with the legislation leaves practitioners subject to liability. More worryingly physicians have reported little change in their approach to decision making. More training in the area is likely needed.