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Mental Capacity Act Best Interests — FRCA Final MCQ

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ModerateMedicolegal & EthicsMental Capacity Act Best InterestsFRCA Final

In England, a 75-year-old woman with severe dementia requires urgent operative fixation of a fractured neck of femur. Despite all practicable communication support, a decision-specific assessment establishes that she lacks capacity to decide about anaesthesia and surgery. There is no valid and applicable advance decision, health-and-welfare attorney or court-appointed deputy. No family member or other appropriate consultee can be contacted, and delaying surgery would risk significant harm. Under what legal framework may anaesthesia and surgery proceed?

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

Reveal the answer and explanation

Correct answer: E — Proceed under sections 4 and 5 of the Mental Capacity Act after a documented best-interests decision.

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

A is correct. Once decision-specific incapacity has been established, sections 4 and 5 of the Mental Capacity Act 2005 allow clinicians to provide treatment that they reasonably believe is in the patient's best interests, with protection from liability for qualifying acts of care or treatment. The assessment, relevant benefits and burdens, known wishes and values, alternatives, and reasons for proceeding should be documented. The Act, rather than a separate emergency doctrine alone, remains the relevant framework. Section 5 applies to healthcare and treatment, including anaesthesia and surgery. Neither relatives nor nurses can provide proxy consent unless they hold the necessary legal authority, and treatment does not require appointment of an attorney or deputy. An IMCA is normally required for serious medical treatment when there is nobody appropriate to consult, but referral must not delay urgent treatment; the reason for proceeding before IMCA involvement should be recorded.

Reference: Department for Constitutional Affairs. Mental Capacity Act 2005 Code of Practice, Chapters 5, 6 and 10. 2007. https://www.gov.uk/government/uploads/system/uploads/attachment_data/file/497253/Mental-capacity-act-code-of-practice.pdf