skip to main content

Capacity and Phobia — MRCPsych Paper B MCQ

Instant feedback + full explanation. One question, done properly.

HardLiaison PsychiatryCapacity and PhobiaMRCPsych Paper B

A 60-year-old woman in an English hospital requires an urgent below-knee amputation for uncontrolled limb sepsis. Without surgery she is likely to die. She has a severe specific phobia of hospitals and surgery. After all practicable steps to support decision-making, she can accurately describe the operation, alternatives and consequences, retains this information and consistently communicates refusal. However, whenever she attempts to compare the prospect of surgery with the risk of death, phobic panic prevents any consideration of the benefits or risks. The assessment concludes that this inability is caused by her phobic disorder rather than by her values or an unwise but reasoned choice. Which conclusion is most consistent with the Mental Capacity Act 2005?

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

Reveal the answer and explanation

Correct answer: E — She lacks capacity because the phobia prevents her using or weighing the relevant information

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

B is correct. Capacity is decision-specific and requires the person to understand, retain, use or weigh the relevant information, and communicate a decision. Here, the severe phobia constitutes an impairment or disturbance of mental functioning and, despite practicable support, causes a specific inability to use or weigh information about amputation against death. The required causal link is therefore established. Understanding the consequences alone (A) or communicating a consistent refusal (E) does not compensate for failure of another functional element. A phobia does not automatically preclude assessment (C); diagnosis alone never determines capacity. The treating clinician normally assesses capacity, although the Court of Protection may resolve serious or unresolved disputes, so D is incorrect. The conclusion concerns this particular decision at this particular time, not global incapacity.

Reference: Office of the Public Guardian, Making decisions: a guide for people who work in health and social care, sections 2 and 6, 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