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Advance Decisions — MRCPsych Paper B MCQ

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HardMental Health LawAdvance DecisionsMRCPsych Paper B

A 40-year-old man with paranoid schizophrenia is detained under section 3 of the Mental Health Act 1983. Eight months earlier, while clinically stable and assessed as having decision-specific capacity, he made a written advance decision refusing blood transfusion on religious grounds. It was signed and witnessed and expressly states that the refusal applies even if his life is at risk. He now has a severe gastrointestinal bleed unrelated to his mental disorder and lacks capacity to decide about transfusion. There is no doubt that the advance decision is valid and applicable. What is the most appropriate legal approach?

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Correct answer: E — Respect the advance decision and do not give the transfusion

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

C is correct. A valid and applicable advance decision has the same effect as a contemporaneous refusal by a person with capacity. Although Part 4 of the Mental Health Act can authorise treatment for mental disorder despite an advance refusal, it does not authorise transfusion for an unrelated gastrointestinal bleed. The refusal must therefore be respected, even if death may result. A is wrong because the Mental Health Act's emergency treatment provisions do not extend to unrelated physical illness. B is wrong because section 3 detention does not displace the Mental Capacity Act for such treatment. D is unnecessary when validity and applicability are undisputed; court involvement is appropriate where there is genuine doubt or disagreement. E is wrong because a nearest relative has no general authority to consent to medical treatment on an adult patient's behalf.

Reference: Office of the Public Guardian, Making decisions: a guide for people who work in health and social care, sections 10 and 14, 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