Mental Capacity Law Cases Overview

A patient's agreement to a medical procedure, allowing the doctor to proceed.

Consent that is clearly stated, either verbally or in writing.

Consent implied through a patient's actions or behavior.

Consent must be given freely and without coercion.

Consent given after the patient is fully informed about the procedure, risks, and alternatives.

The doctor must explain the procedure and its risks in a way the patient understands.

The patient must understand who will perform the procedure.

The doctor is responsible for ensuring the patient understands the procedure and its risks.

The Mental Capacity Act 2005 (MCA) applies to adults and all children except for those under 16. It helps with questions of capacity related to decisions and actions. However, it doesn't cover advanced decisions or Lasting Powers of Attorney (LPAs).

Adults are presumed to have the capacity to make decisions about their health and treatment. This presumption can be challenged if there's evidence that someone lacks capacity according to the principles of the MCA.

In situations where capacity is doubted, doctors must prove that the patient lacks capacity. Simply saying they might be incapable isn't enough. Evidence needs to be provided.

Even if someone has a mental disability, it's crucial to avoid assuming they lack capacity. Each individual's ability to make decisions must be assessed.

The "functional test" for capacity looks at how someone makes decisions, not just their mental state. It asks if they can understand, retain, weigh and believe information about the decision.

Even if a patient makes what seems like an unwise decision, they're still allowed to make it if they have the capacity. Doctors can't force a decision they disagree with.

When acting on behalf of someone who lacks capacity, any decisions made must be in their best interests. This means taking into account their wishes and well-being.

When deciding on treatment for someone lacking capacity, doctors should choose the least restrictive option that still protects the patient's rights. They should try to avoid limiting their freedom.

A person lacks capacity if they are unable to understand relevant information, retain it, use and weigh it up, or communicate their decision.

A two-stage process to determine capacity: 1. Is there an impairment or disturbance of the mind or brain? 2. Is it sufficient that the person lacks capacity to make a particular decision?

When a person lacks capacity, the decision maker must act in their best interests. This means considering all relevant circumstances, not just clinical information.

The decision maker must take steps to determine best interests, including considering the person's past and present wishes, beliefs, values, and what they would likely consider if capable.

The law provides protection from liability when someone acts in the best interests of a person lacking capacity if they took reasonable steps to determine their lack of capacity and reasonably believe they are acting in their best interests.

The doctrine of necessity allowed for actions to be taken without consent in the best interests of a person lacking capacity, but it lacked clear limits.

Now, if a person lacks capacity, the law outlines a duty and power to act in their best interests, providing a clearer framework.

The decision maker must consider all relevant factors, not just clinical information, for a person's best interests. This includes taking into account their past wishes and beliefs, as well as what they would likely consider if capable.

A legal document that grants someone (the donee) the authority to make decisions on behalf of another person (the donor) when the donor loses capacity.

The LPA can cover both personal welfare and property decisions.

The Court of Protection (CoP) has the power to make declarations about a person's capacity and the lawfulness of actions or omissions related to them.

A written statement made by a person while they have capacity about their wishes regarding medical treatment for when they lose capacity.

Advance decisions must be in writing, signed by the person making it, and witnessed. This is necessary for refusing life-sustaining treatment.

A person's right to act in connection with a patient's care, including the right to refuse treatment.

Legal documents that give someone the power to make decisions about the patient's care.

Doctors are limited in their authority to act against an advance decision, LPA/Deputy decision, or court ruling.

The use of force or a threat to use force to make someone do something they resist. Includes restricting freedom of movement, even if not physically restrained.

A person who is under continuous supervision and control and not free to leave the place they are in.

A specific test used to determine if a person is deprived of their liberty.

Legal authority is required for any deprivation of liberty. This can be obtained via the Mental Health Act or DOL safeguards.

A 36-year-old man, capable of consenting to sex, but not to contraception. Due to a history of fatherhood, he opted for a vasectomy considered in his best interests.

An 82-year-old woman living in a nursing home, choosing to return home despite potential risks. The court recognized her capacity to decide where she lives, irrespective of the risks involved.

Illustrates the application of "best interests" when a patient lacks capacity. Despite a long-term relationship and potential for future pregnancy, a woman with autism and 6 children was sterilized to prevent her death.

A case where an anorexic patient with end-stage liver disease refused force feeding, despite posing a danger to herself. The court upheld her advance decision refusing treatment, prioritizing her autonomy and respecting her wishes.

Anorexic patient repeatedly force fed over many years under the Mental Health Act (MHA), despite her wishes and worsening condition. The case highlights the tension between interventions and respecting patient autonomy.