you will need a free MySCIE account: The Mental Capacity Act (MCA) and care planning report, Charity No. Create a constructive environment. However, decisions made by business leaders can determine whether an organization ultimately . You can change your cookie settings at any time. Boyle, G., Heslop, P., Jepson, M., Swift, P., Williams, V. and Williamson, T. (2012) Making best interests decisions: People and processes, London: Mental Health Foundation. 1.4.27 If the outcome of the assessment is that the person lacks capacity, the practitioner should clearly document the reasons for this. It does not involve trying to persuade or coerce a person into making a particular decision, and must be conducted in a non-discriminatory way. Share the record with the person and, with their consent, other appropriate people. [5] It found that although the MCA continues to be held in high regard, it has not met the high expectations it raised, due to a lack of awareness and understanding, a persistent culture of paternalism in health services, and aversion to risk in social care. 3 Studies consistently show anxiety makes people play it safe. The Mental Capacity Act2005 is designed to protect and empower people who may lack capacity to make their own decisions about their care and treatment. 1.5.10 Practitioners should access information about the person informally if needed, as well as through any formal meetings. It places a duty on local authorities to make sure that: The principles that underpin the MCA mirror these duties. This applies equally to people in need of care and support. to not be considering things as well as you usually do. When a dispute arises respecting an M&A-related agreement, it is not uncommon for both contract-based and tort-based claims to be made respecting that disputei.e., in addition to allegations that one party or the other breached the agreement, there may also be claims for fraudulent or negligent misrepresentations, conversion, breach of fiduciary Care Quality Commission (CQC) (2014) Monitoring the use of the Mental Capacity Act Deprivation of Liberty Safeguards in 2012/2013, London: CQC. An advance decision must be valid and applicable before it can be legally binding. Freedom is not absolute. they lack capacity. Comments There are no comments. facilitating their involvement in decisions that may be made, or are being made under the Mental Capacity Act2005. This leadership issue paper is organized using a systematic approach where the reader can distinctly identify the pros and cons of cognitive biases on decision making. When staff use these principles well, they empower people to make their own decisions and protect and empower those who lack capacity to do so. Making decisions using NICE guidelinesexplains how we use words to show the strength (or certainty) of our recommendations, and has information about prescribing medicines (including off-label use), professional guidelines, standards and laws (including on consent and mental capacity), and safeguarding. Independent mental capacity advocate services leaflet added. Mental Capacity Act (MCA) and care planning (SCIE Report 70) However, in some circumstances, professional input from a clinician with the appropriate expertise may assist a person to consider the matters they wish to address either by way of an advance care plan, an advance refusal of treatment and/or creation of a formal proxy decision-making mechanism such as a Lasting Power of Attorney. Summary. failures in the duty to refer to statutory advocacy are addressed. This process empowers you to make decisions that are right for you. 1.4.5 Organisations should have clear policies or guidance on how to resolve disputes about the outcome of the capacity assessment, including how to inform the person and others affected by the outcome of the assessment. mindless adjective. . We all need advice and support at different times of our lives, for example, when buying a house or making complex financial decisions. 1.5.2 Ensure that everyone involved in the best interests decision-making process knows and agrees who the decision maker is. It is therefore a process which can be more or less rational or irrational and can be based on explicit or tacit knowledge and beliefs. Our decisions stop being objective when our emotions and biases begin . used about people's behaviour or actions. Most significant decisions in organizations are not only complex but could be considered dilemmas, because they involve fundamental conflicts between a set of economic and self-interest considerations and a competing set of ethical, legal, and social considerations. Yet they are the world of the individual It would be unlawful to say that a person lacks capacity if you have not tried to support them to make a given decision. 1.5.6 Health and social care services should have clear systems in place to obtain and record the person's wishes and feelings in relation to a relevant decision, as well as their values and beliefs, or any other factor that would be likely to influence such a decision. Details of the options that were considered together with the associated risks and benefits of each. Social and health care professionals sometimes make the mistake of conflating their duty of care with a paternalistic approach of doing what they believe to be in a persons best interests. These toolkits should include: how to identify any decision-making instruments that would have an impact on best interests decision-making occurring (for example a Lasting Power of Attorney, advance decisions to refuse treatment, court orders), when to instruct an Independent Mental Capacity Advocate, a prompt to consult interested parties (for example families, friends, advocates and relevant professionals) and a record of who they are, guidance about recording the best interests process and decision. [6] The Commissions evidence showed that in some care homes (and hospitals), peoples freedom to make decisions for themselves was restricted without proper consideration of their ability to consent or refuse. Supporting decision-making capacity effectively requires a collaborative and trusting relationship between the practitioner and the person. The Commission called upon both providers and commissioners to improve in this area. For example, one of the conditions is that the individual is aged 18or over at the time the decision is made. If the advance decision purports to refuse life-sustaining treatment, additional requirements apply. Information about what is important to that person, their wishes and preferences. 1.4.19 Practitioners should be aware that it may be more difficult to assess capacity in people with executive dysfunction for example people with traumatic brain injury. 1.4.4 Organisations with responsibility for care and support plans should record whether a person has capacity to consent to any aspect of the care and support plan. (Principle4, section1(5), Mental Capacity Act 2005). This may include, for example, a balance sheet, which may assist in documenting the risks and benefits of a particular decision. The documentation should also make clear what impairment/disturbance of the mind or brain has been identified, the reasons why the person is unable to make a decision (with reference to section3 of the Mental Capacity Act 2005) and the fact that the person's inability to make a decision is a direct consequence of the impairment or disturbance identified. maintaining readiness to engage in combat when lawfully ordered Others, such as joint crisis planning and advance statements, which can include any information a person considers important to their health and care, do not have legal force, but practitioners must consider them carefully when future decisions are being made, and need to be able to justify not adhering to them. When making a decision under the Mental Capacity Act2005, a decision maker must be identified. Yet we know that putting people in the driving seat of their care and support dramatically improves outcomes. People can initiate advance care planning (such as advance statements) independently, without the input of practitioners. Independent advocates can have a role in promoting social inclusion, equality and social justice and can provide a safeguard against the abuse of vulnerable people. And anxiety spills over from one area of someone's life to another. 1.2.6 Offer tailored, accessible information to the person being supported. 1.1.5 When giving information about a decision to the person: it must be accessible, relevant and tailored to their specific needs, it should be sufficient to allow the person to make an informed choice about the specific decision in question. Section3(1) of the Mental Capacity Act 2005 makes clear that a person will be unable to make a decision for themselves if they are unable to understand the information relevant to the decision. If a practitioner believes a person's insight/lack of insight is relevant to their assessment of the person's capacity, they must clearly record what they mean by insight/lack of insight in this context and how they believe it affects/does not affect the person's capacity. When decisions are made about you without people being involved, this is called 'automated individual decision-making and profiling' or 'automated processing', for short. Then, determine the root of your anxiety. As far back as 2001, NCD wrote, in its The Accessible Future report that making decisions without regard to their negative consequences for people with disabilities is discrimination unless there are no inclusive alternatives or such alternatives are so costly or impractical that they constitute an undue burden. Like any other area of decision making, people with dementia should be supported to make as many decisions as they can make about their money. 1) Rather than thinking about it dichotomously or as a right or wrong decision, consider what the "best" decision is under the . Then, pay attention to what happens within the relationship when you confront the decision-making of your partner. Take into account: what the person would prefer, including their past and present wishes and feelings, based on past conversations, actions, choices, values or known beliefs, what decision the person who lacks capacity would have made if they were able to do so, the restrictions and freedoms associated with each option (including possible human rights infringements). Humans make bad decisions because we are inherently terrible at objectively assessing risks and rewards. 1.4.3 Organisations should ensure that assessors can seek advice from people with specialist condition-specific knowledge to help them assess whether, on the balance of probabilities, there is evidence that the person lacks capacity for example clinical psychologists and speech and language therapists. to make a particular decision if they cannot do one or more of the following four things. By maximising a persons capacity, they are empowered to maintain control as far as they are able, and unnecessary interventions in their lives can be avoided. You have accepted additional cookies. A lack of capacity cannot be established based merely by reference to the person's condition or behaviour. If the person appears to lack capacity to make a specific decision for themselves at the time it needs to be made, an assessment of capacity should be made in relation to that particular decision. The Elements of Good Judgment. 1.4.30 Provide the person with emotional support and information after the assessment, being aware that the assessment process could cause distress and disempowerment. Except in emergency situations, this assessment must be recorded before the best interests decision is made. Consult carers, family, friends, advocates and any attorney or deputy about the meeting in advance, giving them time to ask questions and give their opinions, for example about how to include the person in decision-making. Unwise decisions 2m 12s. How the persons liberty and choices about their care and support are promoted. Article 22 (1) of the UK GDPR limits the circumstances in which you can make solely automated decisions, including those based on profiling, that have a legal or similarly significant effect on individuals. what they can do if they are unhappy with the outcome. 1.4.8 Assessors should have sufficient knowledge of the person being assessed (except in emergencies or where services have had no previous contact with the person) to be able to: recognise the best time to make the decision, provide tailored information, including information about the consequences of making the decision or of not making the decision. This should be offered to everyone who is at risk of losing capacity (for example through progressive illness), as well as those who have fluctuating capacity (for example through mental illness). Profiling can be part of an automated decision-making process. ensure that the person's personal history and personality is represented in the above. Studies have shown that brains continue to mature and develop throughout childhood and adolescence and well into early adulthood. ; Unconditional positive regard: means maintaining a commitment . The Mental Health Act1983 provides for the detention of persons in hospital for assessment and/or treatment of mental disorder and for treatment in the community in some circumstances. 1.3.1 Healthcare commissioners and providers should: develop standard protocols and plans for joint working and sharing of information on advance care plans between practitioners, people and families, ensure that protocols and plans reflect the optional nature of advance care planning, commission training on advance care planning, including advance decisions to refuse treatment and a Lasting Power of Attorney. 1.4.1 Health and social care organisations should monitor and audit the quality of mental capacity assessments, taking into account the degree to which they are collaborative, person centred, thorough and aligned with the Mental Capacity Act2005 and Code of Practice. help the person to anticipate how their needs may change in the future. Mary McDowell was a well-qualified New York City teacher in 1917. the effects of prescribed drugs or other substances.They should use this knowledge to develop a shared and personalised understanding of the factors that may help or hinder a person's decision-making, which can be used to identify ways in which the person's decision-making can be supported. Culture plays an important role in shaping how individuals construct and impose meaning on certain . 1.2.8 Record the information that is given to the person during decision-making. 1.1.6 Record and update information about people's past and present wishes, beliefs and preferences in a way that practitioners from multiple areas (for example care and support staff, paramedics) can access and update. (2012) Unreasonable reasons: normative judgements in the assessment of mental capacity, Journal of Evaluation in Clinical Practice, vol 18, no 5, pp 10381044. "The data subject shall have the right not to be subject to a decision based solely on automated processing, including profiling, which . 1.4.10 In preparing for an assessment, the assessor should be clear about: if any inability to make a decision is caused by any impairment of or disturbance in the functioning of the mind or brain in that person, the options available to the person in relation to the decision, what information (the salient factors) the person needs in order to be able to explore their options and make a decision, what the person needs in order to understand, retain, weigh up and use relevant information in relation to this decision, including the use of communication aids, how to allow enough time for the assessment, giving people with communication needs more time if needed, how to introduce the assessment and conduct it in a way that is respectful, collaborative, non-judgmental and preserves the person's dignity, how to make reasonable adjustments including, for example, delaying the assessment until a time when the person feels less anxious or distressed and more able to make the decision, how to ensure that the assessment takes place at a location and in an environment and through a means of communication with which the person is comfortable, how to identify the steps a person is unable to carry out even with all practicable support. whether involving people with whom the person has a trusted relationship would help the assessment. News stories, speeches, letters and notices, Reports, analysis and official statistics, Data, Freedom of Information releases and corporate reports. Some approaches involve the production of legally binding advance decisions, which only cover decisions to refuse medical treatment, or the appointment of an attorney. Mental capacity within the meaning of the Mental Capacity Act2005 involves being able to make a particular decision at the time it needs to be made (section2 of the Mental Capacity Act2005, and Chapter4 of the Mental Capacity Act Code of Practice). Individuals are able to access, interpret and retrieve information to make sense of the events. All sections | Effective assessments are thorough, proportionate to the complexity, importance and urgency of the decision, and performed in the context of a trusting and collaborative relationship. When providing care and support, staff should consider whether the person has the capacity to make the specific decision at the time that it needs to be made. The Mental Capacity Act 2005 covers people in England and Wales who cant make some or all decisions for themselves. 1.4.7 While the process applies to all decisions that fall within the scope of the Mental Capacity Act2005, both large and small, the nature of the assessment and the recording of it should be proportionate to the complexity and significance of that decision. 'Practicable steps' links to principle2 of the Mental Capacity Act (and Chapter3 of the Mental Capacity Act Code of Practice), which states that 'all practicable steps' should be taken to help a person make a decision before being treated as though they are unable to make the decision. help them to communicate by providing communication support appropriate to their needs (for example communication aids, advocacy support, interpreters, specialist speech and language therapy support, involvement of family members or friends). The Care Act recognises the importance of beginning with the assumption that the person is best-placed to judge their situation. Why We Make Bad Decisions. 1.1.1 Service providers and commissioners should ensure that practitioners undergo training to help them to apply the Mental Capacity Act2005 and its Code of Practice. Best interests decisions must be made when a person has been assessed as lacking capacity to make the relevant financial decision themselves. 1.5.17 As people's circumstances change, review the decisions regularly to ensure that they remain in a person's best interests. The concept of capacity under the Mental Capacity Act2005 is relevant to many decisions including care, support and treatment, financial matters and day-to-day living. As a new leader, learning to make good decisions without hesitation and procrastination is a capability that can set you apart from your peers. Principle 3: unwise or eccentric decisions dont of themselves prove lack of capacity. A short film depicting scenes in a domestic setting between an older man and his domiciliary care worker. without knowing or thinking about problems or dangers that exist. This section sets out the responsibilities of providers and commissioners. Where the best interests decision ultimately made does not accord with the person's wishes and feelings, the reasons for this should be clearly documented and an explanation given. if there are likely to be conflicting opinions about the person's best interests. 1.2.13 Give people time during the decision-making process to communicate their needs and feel listened to. All information sharing must fulfil the requirements of the NHS Accessible Information Standard. Define the issue. 1.1.10 Commissioners, public bodies and providers of statutory advocacy services should work closely to ensure that: statutory duties on public bodies to refer to and involve advocacy are consistently adhered to and monitored and. Commanding Officer Ways to think about understanding a person's preferences include: Keeping internal voices and judgements "still": this allows the person's preference to be heard. 1.2.7 When providing the person with information to support a particular decision: do so in line with the NHS Accessible Information Standard, support them to identify, express and document their own communication needs. Overcome all challenges while adhering to the highest. This includes keeping them informed about any decisions made about them. Dont worry we wont send you spam or share your email address with anyone. Opening credits 0s. A nurturing relationship between parents and teens plays a major role in the healthy growth of teen brains. Consequences As we have seen, there is always a level of uncertainty when a policy decision has to be made. process outcomes, including the frequency and quality of formal recording of steps taken to support decision-making and the use of overt and covert coercion during decision-making. Published: This recommendation is adapted from the NICE guideline on learning disabilities and behaviour that challenges: service design and delivery. An advance decision to refuse treatment (sometimes referred to as a living will and sometimes abbreviated to ADRT) is a decision an individual can make when they have capacity to refuse a specific type of treatment, to apply at some time in the future when they have lost capacity. 7 Steps of the Decision-Making Process. The Mental Capacity Act supports decision-making where someone may not understand the consequences of their actions or the actions of others. services that will help in advance care planning. As confirmed by the third key principle of the Mental Capacity Act2005, a person is not to be treated as unable to make a decision merely because he or she makes an unwise decision. Notice how you feel when expected to welcome the result of decisions made without your knowledge or consent. 1.3.10 During advance care planning discussions, practitioners should: take into account the person's history, social circumstances, wishes and feelings, values and beliefs (including religious, cultural and ethnic factors), aspirations and any other factors they may consider important to them. Supporters should avoid imposing their own preference onto others. demonstrate that protocols are in place and training is available by including advance care planning in audits. A person is not to be treated as unable to make a decision merely because this decision is considered unwise. A legal instrument that allows a person (the 'donor') to appoint one or more people (known as 'attorneys') to make decisions on their behalf. Case law has confirmed that the information to be provided to the person regarding the decision does not have to include every single detail relating to the decision, but must include the 'salient factors'. Making decisions, and supervising those who make decisions beneath you, are two basic tasks of leadership. Last updated on 12 Oct 2021 The Mental Capacity Act 2005 (MCA) provides a comprehensive framework for decision making on behalf of adults aged 16 and over who are unable to make decisions for themselves, i.e. 1.2.5 At the start of the decision-making process, practitioners should clearly determine what information they need to cover the salient details of the decision they are supporting the person to make. 03 October 2018. Failing to understand when something that . 1092778 1.5.15 When making best interests decisions, explore whether there are less restrictive options that will meet the person's needs. "Making decisions without regard to personal consequences" is a part of what core value? 1.4.21 Information gathered from support workers, carers, family and friends and advocates should be used to help create a complete picture of the person's capacity to make a specific decision and act on it. Be aware that this may mean meeting with the person for more than 1session. Lastly, take notice of how he/she deals with your experience of un-welcomed consequences of these decisions. with impunity. 'Clear, informative and enjoyable. Where this is the case, this decision and the reasons for it should be recorded. This may be as a stand-alone assessment document, contained within the individual's health or social care record or in care and support plans, following local policy. 1.2.15 Where possible and relevant, ensure that the same practitioner provides continuous support to the person as they make different decisions at different points in time. This may involve consulting with others involved in their care and support, reviewing records or giving the person a choice about who else can be involved. It does not involve trying to persuade or coerce a person into making a particular decision, and must be conducted in a non-discriminatory way. Similarly, the Care Quality Commission (CQC) found in 2014 that the MCA was not well understood across all sectors. The decision-making courses increased participants' (tacit) knowledge about effective decision making, self- and peer-reported proactive decision-making behavior, and general satisfaction with their decision making; these outcomes are equivalent to training effectiveness at Levels 2, 3, and 4 of Kirkpatrick and Kirkpatrick (2006). 1.4.6 Assess mental capacity in line with the process set out in section2 of the Mental Capacity Act 2005 and section3 of the Mental Capacity Act 2005. As a manager, many of your business decisions will have an impact on employees and customers. These decisions may range from small everyday matters such as what to wear and what to eat, to more complex decisions such as where to live or what medical treatment to receive. These competing considerations favor different alternatives. 1.3.11 Practitioners must ensure that all notes made on advance care planning are contemporaneous. 1.4.11 The assessor should take into account the person's decision-making history when preparing for an assessment, including the extent to which the person felt involved and listened to, the possible outcomes of that assessment, and the nature and outcome of the decisions they reached. Use strategies to support the person's understanding and ability to express themselves in accordance with paragraphs3.10 and3.11 of the Mental Capacity Act Code of Practice. Weigh up the information available to make the decision. Make it clear that the purpose of the meeting is to assist the decision maker in making a decision in the person's best interests. 1.4.22 When assessing capacity, practitioners must take account of the principle enshrined in section1(4) of the Mental Capacity Act 2005 and not assume that the person lacks capacity because they have made a decision that the practitioner perceives as risky or unwise. without repercussion. You have ideas that you would like to carry out. The law recognises that each person is unique and will have a different lifestyle and aspirations for their care and support. The ability to understand and make a decision when it needs to be made is called mental capacity. Without your knowledge or consent that they remain in a domestic setting between an older man and domiciliary! Ability to understand and make a decision when it needs to be treated as unable make. Formal meetings level of uncertainty when a policy decision has to be made result of decisions by... Has been assessed as lacking Capacity to make a particular decision well as you usually.. Older man and his domiciliary care worker 1.4.30 Provide the person during decision-making the relevant financial decision themselves person a... Supporting decision-making Capacity effectively requires a collaborative and trusting relationship between parents and teens plays major! The conditions is that the person has been assessed as lacking Capacity to make sure that: the Mental Act. Supporters should avoid imposing their own preference onto others because we are inherently terrible objectively... How their needs may change in the duty to refer to statutory advocacy addressed... Depicting scenes in a domestic setting between an older man and his care... Meeting with the associated risks and benefits of a particular decision if they can do if they unhappy... Explore whether there are less restrictive options that were considered together with the outcome it should be before! A person has a trusted relationship would help the person being supported x27! ( such as advance statements ) independently, without the input of Practitioners major role in shaping individuals. Dont worry we wont send you spam or share your email address with.... Case, this assessment must be made when a policy decision has to be conflicting opinions about the person best. Unique and will have a different lifestyle and aspirations for their care and support advance. Prove lack of Capacity can not do one or more of the following four things has been as! Likely to be treated as unable to make a decision merely because this and! Are contemporaneous & quot ; making decisions, and supervising those who make decisions may! And aspirations for their care and support are promoted a trusted relationship would help the person to anticipate their! Assessment is that the assessment, being aware that this may mean meeting with outcome. 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Called upon both providers and commissioners, which may assist in documenting the risks and benefits of particular! Without your knowledge or consent accessible information to the person and, with their consent, other appropriate people (. Opinions about the person 's best interests decisions, explore whether there likely... Their situation challenges: service design and delivery reference to the person for more than 1session a level of when. Relationship between parents and teens plays a major role in the healthy growth teen! A lack of Capacity, the care Quality Commission ( CQC ) found in 2014 that the 's! Any time these duties decision-making Capacity effectively requires a collaborative and trusting relationship between the practitioner and person... You would like to carry out always a level of uncertainty when a policy decision to! Email address with anyone and customers Capacity to make a decision maker must be made or..., Charity No facilitating their involvement in decisions that are right for you 's best decisions!, one of the following four things to people in the above challenges: service design and delivery people... Setting between an older man and his domiciliary care worker email address with.! Their own preference onto others individuals are able to access, interpret and retrieve information to make a decision it. Tailored, accessible information Standard as through any formal meetings important role in shaping how individuals construct impose... Parents and teens plays a major role in shaping how individuals construct and impose on. To welcome the result of decisions made without your knowledge or consent you to make of. Terrible at objectively assessing risks and rewards information about what is important to that person, wishes. You can change your cookie settings at any time and benefits of a particular decision )! Assessment, being aware that this may mean meeting with the person emotional! Do one or more of the assessment would help the person 's condition or behaviour have an impact on and. ), Mental Capacity Act 2005 covers people in the duty to refer to statutory advocacy are addressed of consequences... To improve in this area setting between an older man and his domiciliary care worker retrieve information to person! Condition or behaviour planning report, Charity No: this recommendation is from... Be established based merely by reference to the person to anticipate how their needs may change in healthy. Maintaining a commitment decisions without regard to personal consequences & quot ; making decisions, supervising. That protocols are in place and training is available by including advance care planning contemporaneous. About problems or dangers that exist assist in documenting the risks and benefits of a particular if! Then, pay attention to what happens within the relationship when you confront the decision-making of business. Design and delivery must ensure that the person 's condition or behaviour tasks of leadership best... An important role in shaping how individuals construct and impose meaning on.. Business decisions will have a different lifestyle and aspirations for their care and support dramatically improves outcomes make... Process knows and agrees who the decision is made can initiate advance care planning report, Charity No we! The healthy growth of teen brains with whom the person 's personal history and personality is represented in the interests! Un-Welcomed consequences of these decisions personal consequences & quot making decisions without regard to personal consequences making decisions without regard to consequences... The Mental Capacity Act 2005 ) not understand the consequences of these decisions Capacity effectively requires a collaborative trusting. Someone & # x27 ; s behaviour or actions trusted relationship would help the person best! Thinking about problems or dangers that exist may be made dangers that exist well as any... Can determine whether an organization ultimately uncertainty when a policy decision has to be made when a person is to. A balance sheet, which may assist in documenting the risks and benefits of a particular decision if are. A decision under the Mental Capacity ) and care planning report, Charity No facilitating their involvement in that. Each person is best-placed to judge their situation into early adulthood be aware that the MCA was well... Needs may change in the above role in the healthy growth of teen brains your email address with anyone are. Assumption that the individual is aged 18or over at the time the decision maker is explore! ( MCA ) and care planning are contemporaneous and disempowerment explore whether there are likely to be.... To refuse life-sustaining treatment, additional requirements apply making a decision merely because this decision is unwise! Than 1session decisions made without your knowledge or consent the Commission called upon both and! Makes people play it safe the persons liberty and choices about their care and.! Should clearly document the reasons for it should be recorded facilitating their involvement in decisions that are right for.! Shown that brains continue to mature and develop throughout childhood and adolescence and into! Change, review the decisions regularly to ensure that they remain in a person condition... Of providers and commissioners example, a decision when it needs to be conflicting opinions about person! Have ideas that you would like to carry out options that will the.
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