IMCA information for doctors about medical decisions

When must an IMCA be involved?

The Mental Capacity Act (MCA) requires doctors to involve an independent mental capacity advocate (IMCA) for serious medical treatment decisions when:

The Code of Practice lists the following examples of possible serious medical treatments:

Any decision not to offer the above treatments would similarly require the involvement of an IMCA.

What about emergency treatment?

The only situation in which the duty under the Act to instruct an IMCA need not be followed is when an urgent decision is needed, for example, to save a person’s life. However, if further serious treatment follows an emergency situation, there will be a need to instruct an IMCA.

Is an IMCA required if the person is being treated under the Mental Health Act?

Responsible bodies do not have to instruct an IMCA for patients detained under the Mental Health Act 1983, if:

If serious medical treatment proposed for the detained patient is not for their mental disorder, the patient then has a right to an IMCA – as long as they meet the MCA’s requirements. So a detained patient without the capacity to consent to cancer treatment, for example, should qualify for an IMCA if they do not have any family or friends with whom it would be appropriate to consult.

Who should involve the IMCA?

A representative of the NHS body that is considering the treatment options or is arranging the treatment must instruct the IMCA.

NHS body is defined in regulations as either a strategic health authority; an NHS foundation trust; a primary care trust; an NHS trust; or a care trust.

The doctor making the decisions will usually instruct the IMCA by completing a referral form. There may also be local arrangements that allow other medical staff to make the referral.

Contact details of the IMCA services for each local authority are provided on the find an IMCA page.

What will the IMCA do?

The IMCA supports and represents the person in the decision-making process. This will involve:

  • speaking to the person themselves where possible
  • speaking to the doctor and other medical staff about the proposed treatment
  • looking at relevant health records (IMCAs have a statutory right to access and take copies of these).

Role of IMCA

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The IMCA is there to ensure that the person’s wishes and feelings have been considered and that the MCA is being followed.

The IMCA has a statutory right to ask for a second medical opinion. The IMCA is required to write a report which should be considered by the doctor before making their decision.

What are the doctor’s statutory obligations?

Where a doctor is making what could be regarded as a serious medical treatment decision for someone who lacks the capacity to make that decision themselves and where there are no family or friends with whom it is appropriate to consult, the MCA imposes the following duties on doctors:

Key resources for medical decisions