Deprivation of Liberty Safeguards (DoLS)

Deprivation of Liberty Safeguards (DoLS) & Restraint

The Deprivation of Liberty Safeguards (DoLS) is a legal framework in the United Kingdom that provides a means of protecting the rights of people who lack the capacity to make decisions about their own care and treatment and who are therefore at risk of being deprived of their liberty. This framework is established under the Mental Capacity Act 2005 and applies to people who live in care homes or hospitals. Deprivation of Liberty Safeguards (DoLS) govern deprivations of liberty themselves, which importantly are different from the use of restraint.

How do the Deprivation of Liberty Safeguards (DoLS) work?

The purpose of DoLS is to ensure that any deprivation of liberty is in the best interests of the person concerned and that it is necessary, proportionate, and the least restrictive option. The safeguards involve a series of assessments and reviews to ensure that the person’s welfare and rights are being protected, and that the deprivation of liberty is subject to ongoing review and oversight.

If a person is considered to be necessarily deprived of their liberty, the responsible person (such as a care home manager or hospital manager) must apply for authorisation under the DoLS. A court-appointed supervisory body must then assess the situation and determine whether the deprivation of liberty is necessary and in the person’s best interests.

The Deprivation of Liberty Safeguards aim to strike a balance between protecting the rights and welfare of people who lack capacity and ensuring that their care and treatment is appropriate. They are designed to provide an extra layer of protection for some of the most vulnerable members of society.

The CQC has more on DoLS and the MCA here.

A DoLS Example in Practice

An example of a Deprivation of Liberty Safeguard (DoLS) would be a situation where an elderly person with dementia is living in a care home and requires 24-hour care and supervision due to their condition. They are unable to make decisions about their own care and treatment and are at risk of harm if left unsupervised. They wish to leave the care home and return home in spite of this, but refuse all home support & insist they can remain independent.

In this scenario, the care home manager would need to apply for authorisation under the DoLS framework to ensure that the person’s deprivation of liberty is necessary, proportionate, and in their best interests. The approach they might take would be to seek to keep them at the care home & prevent them from leaving.

The following steps would typically be taken:

  1. Assessment of capacity: A professional would assess the person’s capacity to make decisions about their own care and treatment and determine that they lack capacity.
  2. Best interests assessment: A best interests assessment would be carried out to determine whether it is in the person’s best interests to be deprived of their liberty and what alternative options are available.
  3. Authorisation: If it is considered necessary to deprive the person of their liberty, the care home manager would apply for authorisation under the DoLS.
  4. Review: The deprivation of liberty would be subject to ongoing review and assessment to ensure that it remains necessary and in the person’s best interests.

This example demonstrates how the DoLS framework can protect the rights and welfare of people who lack capacity and ensure that their care and treatment is appropriate.

What is a Deprivation of Liberty?

Deprivation of liberty refers to a situation in which an individual’s freedom of movement is restricted by their care arrangements. If this happens outside the DoLS framework, it might be without their consent and without a legal framework to justify the restriction.

This can occur in a number of different settings, including care homes, hospitals, and other institutions. It can take many forms, including restrictions on the individual’s ability to leave a certain area, control over their daily routines and activities, and limitations on their ability to make decisions about their own care and treatment.

Unsanctioned deprivation of liberty is a serious issue, as it can have a significant impact on an individual’s well-being, autonomy, and human rights. It is therefore subject to legal safeguards in many countries, including the UK, where the Deprivation of Liberty Safeguards (DoLS) were introduced to protect the rights and welfare of people who lack capacity and are at risk of being deprived of their liberty.

The term deprivation of liberty and deprivation of liberty safeguards themselves are easy to confuse. Deprivation of liberty can refer to a situation in which an individual’s freedom of movement is restricted without their consent and without a legal framework to justify the restriction. Deprivation of Liberty Safeguards on the other hand are about ensuring that the former, where they are necessary, are ethical & justifiable under the law.

The Deprivation of Liberty Safeguards aim to protect the rights and welfare of people who are at risk of being deprived of their liberty and to ensure that any deprivation of liberty is necessary, proportionate, and in their best interests.

Deprivation of Liberty and Restraint

The Deprivation of Liberty Safeguards (DoLS) and the use of restraint are related, but they are different concepts.

DoLS is a legal framework that applies to people who lack capacity to make decisions about their own care and treatment and who are at risk of being deprived of their liberty as a result of their care arrangements. It aims to ensure that any deprivation of liberty is ethically justifiable and permissible under the law.

Restraint, on the other hand, refers to the use of physical or chemical measures to limit a person’s movement or behavior. This can include the use of restraints such as bed rails, wrist straps, or chemical restraint in the form of sedation.

The use of restraint can sometimes be necessary in the care and treatment of people who lack capacity and are at risk of harm to themselves or others. However, the use of restraint must be in the person’s best interests and must be proportionate and necessary. If a person is considered to be deprived of their liberty as a result of their care arrangements, and the use of restraint is a part of those arrangements, the DoLS framework would apply to ensure that the deprivation of liberty is authorised and subject to ongoing review and assessment.

While the DoLS framework and the use of restraint are related, the DoLS focuses on the protection of the rights and welfare of people who lack capacity and are at risk of being deprived of their liberty, while the use of restraint focuses on the physical or chemical measures used to limit a person’s movement or behavior. Also, it is possible to exercise a deprivation of liberty without the use of restraint.

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