Advance decisions, mental capacity, and suicidal behaviour
Research type
Research Study
Full title
Mental capacity, advance decisions, and suicidal behaviour: developing guidance for clinicians
IRAS ID
191199
Contact name
L Macrae
Contact email
Sponsor organisation
University of Manchester
Duration of Study in the UK
1 years, 9 months, 4 days
Research summary
In England and Wales, the Mental Capacity Act 2005, defines capacity as the ability to understand, retain, and weigh up relevant information, and to communicate the decision by any means. The Act enables people aged 18 or over, with capacity, to refuse medical treatment even when that treatment may be lifesaving. These pre-specified refusals of treatment are commonly called advance decisions or directives and are legally binding in the UK.
The Mental Capacity Act is designed to empower individuals in deciding their own medical care if they lose capacity in the future; but they raise particular issues in the context of suicidal behaviour. Suicidal intent varies within and between self-harm episodes and a person´s mental state can change markedly from the time of writing the advance decision to presenting at hospital. Many people who attempt suicide also have a psychiatric diagnosis but that is not enough to treat an individual against their wishes. There is little practical guidance to help clinicians decide whether or not to comply with an advance decision which relates to the refusal of potentially life-saving treatment following self-harm.
The aim of this study is to inform the medical management of people who present to hospital with an advance decision in the context of suicidal behaviour.
We will look at the literature to determine the extent of the issue internationally and search local databases for the characteristics and outcomes of people who have presented to hospital with an advance decision in the context of suicidal behaviour. Clinicians and community group members aged 18 and over will be invited to share their knowledge, experience, and views on the topic through a web-survey (clinicians) and focus groups (clinicians and community group members).
The results of this study will contribute to the development of clinical guidance for people who present with suicidal behaviour and advance decisions and hopefully contribute to a consistent evidence based treatment approach.
We will not discuss suicidal behaviour in the context of terminal illness as it has additional ethical issues and is beyond the scope of this study.
REC name
North West - Greater Manchester West Research Ethics Committee
REC reference
16/NW/0173
Date of REC Opinion
11 Mar 2016
REC opinion
Favourable Opinion