01-30-2019, 11:48 PM
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Join Date: Nov 2005
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Hi, if you search inside this level 5 handbook on amazon for 'informed choice' click top page 68.
Issues of individual capacity that could affect informed choice
Anyhing that affects an individual's capacity to weigh up information and make choices may compromise their ability to make choices. Decisions about capacity are judged on the basis of competence. Factors that compromise an individual's ability to make decisions may be internal to the individual - they may be affected by things such as mental or physical ability, intellectual capacity, anxiety or pain, or factors such as ability to communicate, age, or culture - or they can be as a result of extenal factors, such as control or protective behaviour of others, lack of adequate information, or not being presented with real choices.
Competence is not easy to define or assess and yet it is an important element of determining the level of decision making that should be supported. One definition of it is the measure of 'fitness' of an individual to act or behave in certain situations. In health and social care, standards of comeotence tend to focus on the ability to make choices. Assessment of competence then is not dissimilar from assessing the conditions required for informed consent.
Values and principles
- A person must be assumed to have capacity unless it is (formally) established that they do not have capacity.
- A person is not to be treated as unable to make a decision unless all practicable steps to help him/her do so have been taken without success.
- A person must not be treated as unable to make a decision merely because he/she makes an unwise one.
- An act done, or decision made, under the Act for and on behalf of a person who lacks capacity must be done or made in his/her best interests.
- Before the act is done, or the decision is made, regard must be made to whether the purpose for which it is needed can be as effectively achieved in a way that is less restrictive of the person's rights or freedom of action.
Similarly, page 89 of this handbook states
The principle of informed choice
Informed choice is supported by the principle of autonomy, which we can define as
'Self-rule that is free from both controlling interferences by others ans from personal limitatioms that prevent meaningful choice such as inadequate understanding' (Beauchamp and Childress, 2001, p.58)
- There are at least four elements necessary for autonomous decision making:
- Understanding the value of respect for persons and their differences.
- The ability to be self-governing and being able to determine one's own personals goals and preferences.
- The capacity ot cpompetence to make choices or decisions nased on deliberation and reason.
- The freedom to make choices for oneself and to act on these
(Cuthbert and Quallington 2008)
Informed choice and autonomous decision making require more than simple articulation or preference in order to meet the requirement for informed choiuce, an individual must be given a choice of alternatives, even if that choice is simply to do, or not to do, something. Making a meaningful choice also entails that you unerstand what those choices mean and what the impact of those choices could signify. It is the responsibility of the practitioner to ensure that the individual has sufficient information, which has been provided in an underatandable way to enable them to make good choices. If the indivudual does not understand the information the onus is on the practitioner to find and alternative way of explaining it. It is not sufficient to claim that, becasue you told them something, they were adequately informed. Checking understanding about what they think they are being told by questions and getting them to summarise what you have said is a useful way of assessing this.
For informed choice, it is a requirement that an individual has the capacity to manipulate the information that they have been given in order for them to reach a decision.
That involes time and oppotunity for reflection.
Hope this all helps xx |
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