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Capacitous Refusal of Life-Sustaining Treatment — MRCPsych Paper B MCQ

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ModerateLiaison PsychiatryCapacitous Refusal of Life-Sustaining TreatmentMRCPsych Paper B

In an English respiratory unit, a liaison psychiatrist assesses a 50-year-old man with motor neurone disease who refuses proposed ventilatory support. After receiving appropriate communication support and information about the benefits, burdens and alternatives, he can understand and retain this information, use and weigh it—including that refusal is likely to result in death—and consistently communicate his voluntary decision. No mental disorder is identified. What is the correct legal approach?

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Correct answer: C — Respect the refusal and document the capacity and consent assessments

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

B is correct. This is a contemporaneous, voluntary and informed refusal by an adult with decision-specific capacity: he can understand, retain, use or weigh the relevant information and communicate his decision. The refusal must be respected even though death is the likely consequence; the assessment and discussion should be documented, with ongoing symptom control and palliative support offered. A incorrectly treats the gravity or perceived unwisdom of the choice as incapacity. C is inappropriate because no mental disorder requiring treatment under the Mental Health Act is identified, and ventilation treats his physical disease. D and E are incorrect because court approval is not routinely required for a clear capacitous refusal. Court involvement may be appropriate if there is a genuine unresolved dispute about capacity or lawfulness.

Reference: NHS, Consent to treatment, section 'Defining consent', last reviewed 8 December 2022. https://www.nhs.uk/tests-and-treatments/consent-to-treatment/