Making decisions about screening

A guide for family, friends and carers

This leaflet gives information for those who care for people who do not have the mental capacity to make decisions about attending for health screening.

What is mental capacity?

Having mental capacity means being able to make your own decisions. Someone who lacks capacity cannot do one or more of the following four things:

  • Understand information given to them
  • Retain that information long enough to be able to make a decision
  • Weigh up the information available to make a decision
  • Communicate their decision Some people may not be able to make decisions for certain periods of time, for example, those with a mental illness.

The Mental Capacity Act has five key principles:

  • All adults have the right to make decisions for themselves, unless it can be shown that they are not capable of making them
  • Everyone should be given all the help and support they need to make a decision
  • People are allowed to make what others might think is an unwise decision
  • Actions or decisions taken on behalf of someone else must be shown to be in their best interests
  • People who lack capacity must not be restricted unnecessarily

Anyone - a health or care professional, other professional, relative or carer - might need to decide whether a person has the capacity to make a particular decision. Some people may have the capacity to consent with help and support. This could be from an interpreter, or from a learning disability nurse, for example.

The Act allows people over 18 to appoint someone to make their health decisions for them in the future, if they cannot make these decisions for themselves. This is called a Personal Welfare Lasting Power of Attorney (LPA). The person who is chosen to make the decisions is called the Attorney. All decisions that an Attorney makes must be in the person’s best interests.

If you care for someone who does not understand what it means to appoint an Attorney, you might need to consider applying to the Court of Protection in order to be granted permission to make decisions on their behalf as a Deputy.

What is screening?

Screening aims to detect certain forms of cancer at an early stage, which may allow them to be treated more effectively. Screening does not detect every abnormality and may result in further tests or investigations being needed.

Invitations for screening are sent on a regular basis. This is usually every two or three years, first with an invitation letter and then a reminder letter if the person does not attend for screening.

How do I decide on a person’s best interests?

There are several things to consider:

  • Might they regain capacity, in which case the decision could be delayed
  • They must be involved in any decision
  • Have they previously expressed any wishes or feelings, beliefs or values that might affect a decision?
  • Are there any other factors they would be likely to consider if they were able to?

If you are assessing what is in the person’s best interests, you must consult with carers and anyone with an interest in their welfare. You must consult anyone who the person concerned said should be consulted, and any Attorney or Deputy that has been appointed.

All the factors will need to be weighed up to decide what is in the person’s best interests.

What if I decide against screening for the person?

Once an invitation is received, this can be ignored if screening is not felt to be in the person’s interests at that particular time. A reminder letter will be sent, but this too can be ignored.

In a minority of cases all invitations for screening can be cancelled. If the person cannot and never will be able to consent to screening, this might be in their best interests. In this case, the person’s GP will need to confirm this in writing to the Regional Programme Coordinator.

Where can I get further information?

This is available on the website of the Office of the Public Guardian, at:

http://www.publicguardian.gov.uk/

Further guidance on the Mental Capacity Act can be found at Electronic Information booklets:

www.dca.gov.uk/legal-policy/mental-capacity/publications.htm

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