Action for Advocacy has produced guidance on the involvement of Independent Mental Capacity Advocates (IMCAs) in serious medical treatment (SMT) decisions.

It is also important for practitioners dealing with patients who lack capacity to be aware that this document is in circulation and will be used as a reference by IMCAs.

Serious medical treatment is defined as treatment which involves providing, withdrawing or withholding treatment in circumstances where:  

  • there is a fine balance between the benefits and burdens to the patient;
  • a fine balance between a choice of treatments; or
  • where treatment will likely involve serious consequences for the patient.  

The guidance provides a general statutory background, including the rights and responsibilities of IMCAs and the role of decision makers under the Mental Capacity Act 2005 (the MCA).

It also outlines the following, which those acting as decision makers under the MCA can expect to see filter through in their discussions with IMCAs:  

  • who should instruct an IMCA;
  • how IMCAs can prioritise cases; and
  • how IMCAs can raise concerns when they are not satisfied with the decision making process.  

Specific mention is made of handling cases which involve end of life care, Do Not Attempt Resuscitation, PEG feeding, chemotherapy, dental care and Electro Convulsive Therapy.