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Handbook of Palliative Medicine

Mental Capacity

The Mental Capacity Act 2005 is a cornerstone legislation crucial for protecting the autonomy and rights of individuals facing mental capacity challenges, particularly when decisions need to be made. At its heart lies the rigorous assessment of an individual’s capacity to make specific decisions, a multifaceted process requiring a comprehensive understanding of the individual’s circumstances, capabilities, and the decision at hand. It is therefore always time and decision specific.

Decisions that require this assessment range from what to eat for breakfast to whether to undergo invasive tests and treatments.

The five key principles of the mental capacity act:

  1. Everyone is presumed to have capacity
  2. Individuals should be supported to make their own decisions
  3. Capacitous adults are allowed to make unwise decisions
  4. Make decisions for those without capacity in their best interests
  5. Ensure these decisions follow the least restrictive options

Mental Capacity Act reminider

Capacity assessment is a two-stage process and is the responsibility of all professionals in contact with a patient. The first stage is to identify those who may not have capacity to undertake a decision using the question: “Does this person have a disturbance or impairment of their mind or brain which may impair their decision making whether due to illness or external factors”? This impairment could be due to dementia, delirium, other brain pathology, medications, or reduced conscious level. It should be documented whether this impairment is likely to be permanent, temporary, or fluctuating.

The second stage is to assess whether the person can understand, retain, weigh up and communicate the relevant information to make this decision. Appropriate support must be given to optimise the chance of a person being able to perform all these functions. If however they are unable to do any one of these, they are deemed to lack capacity. If it is felt that the person lacks capacity, a decision must be made on their behalf in their best interests.

This assessment must be documented in the medical notes but remember capacity can change and is only valid at the time of assessment.