Understanding the mental capacity act 2005

M R C O G PA R T 2 · S O S P O C K E T C A R D · K N O W L E D G E A R E A 2 – T E A C H I N G A N D R E S E A R C H

Understanding the Mental Capacity Act 2005 Nicholas N, Nicholas S. Understanding the Mental Capacity Act 2005: a guide for clinicians. TOG 2010;12:29–34. doi:10.1576/toag.12.1.029.27555

16 yrs 18 yrs Balance of AGE FROM WHICH THE ACT APPLIES MINIMUM AGE: ADVANCE DECISION / LPA probabilities DONOR STANDARD TO REBUT CAPACITY (S2(4))

DO N' T-M IS S FA C TS

  1. Capacity presumed from 16 yrs (s1(2)); rebut on the balance of probabilities (s2(4))

  2. Unwise decision ≠ incapacity (s1(4)) – capacitous refusal of blood is lawful

  3. Partner/husband cannot give proxy consent; family are consulted (s4(7)), not decision-makers

  4. Act in best interests (s1(5)/s4); s5 gives legal protection, s6 allows proportionate restraint

  5. Valid advance decision beats best interests; life-sustaining refusal must meet s25(6) formalities

  6. Basic nursing care (hygiene, warmth, food, pressure care) can never be refused in advance

  7. LPA donee cannot refuse life-sustaining treatment unless specified; later LPA overrides earlier advance decision (s25(2)(b))

  8. Family–doctor conflict over best interests → consult the Independent Mental Capacity Advocate

KEY SECTIONS AT A GLANCE

s1(2) presumption · s1(4) unwise · s1(5) best interests s2 two-stage test · s3(3) retention · s3(4) consequences

s4(7) consult · s4(9) reasonable belief · s4(10) life-sustaining s5 protection · s6 restraint · s9 LPA · s25(6) formalities

No statutory provision for pregnancy – case by case

ABBREVIATION KEY

MCA — Mental Capacity Act 2005 Advance decision — living will / advance directive / advance refusal

LPA — Lasting Power of Attorney Re C — common law case underpinning the test for capacity

Donor / Donee — person creating the LPA / attorney appointed to Battery — unlawful touching – tort/criminal offence decide for them OPG — Office of the Public Guardian IMCA — Independent Mental Capacity Advocate

Source: The Obstetrician & Gynaecologist (TOG), RCOG journal — doi:10.1576/toag.12.1.029.27555

Clinically reviewed by NHS obstetricians and gynaecologists

MRCOG AI is an independent educational tool. It is not affiliated with, endorsed by, or connected to the Royal College of Obstetricians and Gynaecologists (RCOG).

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