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IMCA for Unbefriended Patient — SCE Palliative Medicine MCQ

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ModerateEnd of Life CareIMCA for Unbefriended PatientSCE Palliative Medicine

A 72‑year‑old man with advanced lung cancer is dying in hospital. He has no next of kin and no friends and was admitted from a homeless shelter. Who ensures his interests are represented in best‑interests decisions about his care and treatment?

Educational content. Not a substitute for clinical judgement or local policy.

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Correct answer: A — An Independent Mental Capacity Advocate (IMCA) must be instructed — the Mental Capacity Act requires IMCA involvement when a person lacking capacity has no one appropriate to consult

Explanation lettering: D = shown as A · A = shown as B · B = shown as C · E = shown as D · C = shown as E

Under section 37 of the Mental Capacity Act 2005, where a person lacks capacity and has no appropriate family or friends to consult, an NHS body must instruct an Independent Mental Capacity Advocate (IMCA) if a serious medical treatment decision is contemplated. The IMCA does not decide but represents the person’s wishes, beliefs and values to inform the clinician’s best‑interests judgment. None of the other options meet the legal requirement: social workers or chaplains have no statutory decision authority (A, C), clinicians cannot lawfully proceed without the IMCA when eligibility criteria are met (B), and next of kin has no legal meaning and a shelter manager is neither independent nor appropriately related (E).

Reference: GOV.UK guidance 'Making decisions: the Independent Mental Capacity Advocate service' (June 2025); Mental Capacity Act 2005 Code of Practice section on serious medical treatment (section 37), https://www.gov.uk/government/publications/independent-mental-capacity-advocates/making-decisions-the-independent-mental-capacity-advocate-service-web-version