Ethics and the Mental Capacity Act (MCA)

mike stone 29/08/21 Dignity Champions forum

I have recently been involved in a Twitter exchange (I am not willing to describe it as 'a discussion') which I found deeply confusing. I think, it was suggested - in fact, I think it was stated more forcefully than as suggestion - that if I read about ethics, the pieces I write about end-of-life, the Mental Capacity Act and cardiopulmonary resuscitation (EoL/MCA/CPR) would be 'better'. I don't believe this - and I gave the person who suggested it the opportunity to 'rewrite one of my pieces with the benefit of 'his own greater expertise in ethics'' to prove the point to me, but the person did not do that - and I will now try to explain why.

For a decade, I have been describing and exploring various EoL/MCA/CPR issues which bother me: usually because something seems wrong from my patient/relative/family-carer perspective, but sometimes because something is illogical or [especially for policy and protocol] internally contradictory or inconsistent. I want these issues to be 'thrashed-out and improved by means of discussions between professionals and layfolk'. So I will have a resistance, to any suggestion that a really 'niche' understanding - such as 'you NEED TO HAVE READ books about ethics in order to adequately understand the issue' - is necessary: few patients, relatives etc will be able to claim such expertise. And the implication of any such claim that 'specialist expertise which cannot easily be elaborated to layfolk, allows a person with that expertise to make better decisions' is that doctors will often be able to make better decisions than most relatives can.

Many of my written 'analyses/explorations" do not involve ethics: they often involve logical issues. But, I wish to be clear: I ABSOLUTELY ACCEPT that the MCA has an ethos, and that there are ethical positions within the MCA. The point is - WITHIN the MCA. We must "discover' the ethics of the MCA, by reading the words of the MCA. And we will discover, that a capacitous person can choose to die, instead of accepting a treatment which would save the person's life. We will discover, that welfare attorneys decide what is in an incapacitous person's best interests, and it seems to me the ethics of that, is not 'attorneys can be shown to make better decisions than doctors' and is in fact 'the patient WANTED the attorney, not the doctors, to make the best-interests decisions'. Welfare attorneys can be given authority over life-sustaining treatments - but court deputies cannot. The ethics? Presumably, that the patient chose the welfare attorney, but a court appointed a deputy. So there are ethics within the MCA. But as those ethics have been incorporated in the Act"s words, if we apply the Act's words correctly, then we are applying the Act's ethics correctly. I will mention in passing: as anyone who has read my pieces will know, I am aware that 'applying the Act's words correctly' is not as simple as it might sound!

BUT WE CANNOT HAVE anyone, such as doctors and even judges (and I have read court rulings when judges it appears did this - fortunately the situation seems to be much better since about 2014) "defeating the ethics WITHIN the MCA, by applying ethics from OUTSIDE the MCA'. If we allow that, it defeats the purpose of the MCA and it makes things chaotic!

Many of my pieces, DO raise what could be described as 'ethical issues'. I am happy for others to describe the questions my pieces pose - usually how are conflicting but desirable objectives to be balanced, or how can 'emergency situations' when the participants possess different knowledge sets be addressed - as 'ethical questions'. But I will continue, to use 'how can that be fair?', 'come and stand in my shoes before you say that', 'how on earth could I possibly prove that! - so you must not expect me to prove that!' and the like. Because I want EVERYONE to be able to join in discussion and debate about EoL/MCA/CPR.

I fear I will become even more 'rambling' if I continue - so I will stop here.