Capacity Assessment — MRCPsych Paper B MCQ

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EasyLiaison PsychiatryCapacity AssessmentMRCPsych Paper B

A liaison psychiatrist is asked to assess capacity in a 78-year-old woman who has been diagnosed with a gangrenous foot requiring amputation. She refuses surgery. Which of the following is NOT one of the four functional criteria for assessing capacity under the MCA 2005?

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Correct answer: B — Ability to make a wise decision

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

D is correct. Section 3(1) of the Mental Capacity Act 2005 defines the functional test by four abilities only: to understand the relevant information (A), to retain it long enough to decide (B), to use or weigh it as part of the decision-making process (C), and to communicate the decision by any means (E). The perceived wisdom of the outcome is not a criterion: section 1(4) states that a person is not to be treated as unable to decide merely because the decision is unwise, so a capacitous patient may lawfully refuse a limb-saving or life-saving amputation. A, B, C and E are attractive only because all four are genuine limbs of the test; candidates err by adding an outcome-based fifth limb, which conflates disagreement with clinical advice, or poor insight, with incapacity. Capacity is decision- and time-specific, and support (simple language, visual aids, optimal timing) must be offered before concluding incapacity.

Reference: Mental Capacity Act 2005, section 3 (Inability to make decisions), with section 1(4) principle, 2005. https://www.legislation.gov.uk/ukpga/2005/9/section/3