Capacity

Question 1

What are the four rules of assessing capacity?

Answer 1

Patient has capacity until proven otherwise
Capacity is decision-dependant (patient may have capacity for one decision, but not necessarily another)
If a patient lacks capacity you must act in their best interests
If a patient has made a strange or irrational decision that doesn’t mean they lack capacity

Question 2

What are the two steps in capacity assessment?

Answer 2

1) Does the patient have impairment/disturbance of brain function?
- if NO, the patient has capacity and step two isn’t required
2) If YES, does this mean they are unable to make a decision as a result?

Question 3

How do you assess whether a patient is unable to make a decision about their own treatment?

Answer 3

Consent test (must be able to do all of the following)

• understand information relevant to the decision (e.g. consequences and risks)
• retain the information long term
• weight up/use the information to make a decision (pros and cons)
• communicate the decision

Question 4

How does a doctor decide the best interests of a patient who lacks capacity?

Answer 4

Persuade the patient to be involved in the decision making
Take into account their beliefs/views
Consult anyone names by parents/carers to help determine what is in their best interests
Check for any lasting power of attorney
Consider if they may regain capacity

Question 5

Give examples of those who may lack capacity.

Answer 5

Patients with

• dementia
• severe learning disability
• a brain injury
• a mental health illness
• a stroke
• loss of conciouness due to anaesthetic or sudden accident