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Capacity Assessment — MRCPsych Paper B MCQ

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ModerateLiaison PsychiatryCapacity AssessmentMRCPsych Paper B

A 46-year-old man on a medical ward requires an urgent blood transfusion for a gastrointestinal haemorrhage. He refuses the transfusion because of his religious beliefs. A decision-specific assessment establishes that he understands the nature and purpose of the transfusion, retains the relevant information, uses and weighs the benefits, alternatives and risk of death, and clearly communicates a voluntary and consistent refusal. According to the Mental Capacity Act 2005, what is the most appropriate action?

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Correct answer: A — Respect his refusal of the transfusion

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

B is correct. Capacity is specific to the decision and time. This patient can understand, retain, use or weigh the relevant information and communicate a voluntary decision; therefore, his capacitous refusal must be respected even though death may result. A religiously motivated or apparently unwise decision does not itself demonstrate incapacity. The MCA best-interests framework applies only when the person lacks capacity, so A is incorrect. A deprivation of liberty authorisation does not provide authority to override this capacitous treatment refusal. Section 2 requires a mental disorder warranting detention and would not authorise a transfusion for an independent physical condition in this scenario. Family members may support communication but cannot make or override a decision for an adult who retains capacity.

Reference: Office of the Public Guardian. Making decisions: a guide for people who work in health and social care, sections 4, 6 and 10. Updated 19 May 2026. https://www.gov.uk/government/publications/health-and-social-care-workers-mental-capacity-act-decisions/making-decisions-about-your-health-welfare-or-finances