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MCA Functional Test — MRCPsych Paper B MCQ

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ModerateMental Health LawMCA Functional TestMRCPsych Paper B

In England, a 78-year-old man with dementia is assessed under the Mental Capacity Act 2005 regarding where he should live. After all practicable support has been provided, he can understand and retain the relevant information and communicate a preference. However, because of his cognitive impairment, he cannot compare the risks and benefits of the available options or apply them to his own circumstances. Which MCA concept most directly identifies the failed component of the capacity assessment?

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Correct answer: C — Use or weigh relevant information

The correct answer is C. The MCA functional test examines whether the person can understand, retain, use or weigh the relevant information, and communicate a decision. This man cannot compare the risks and benefits or apply them to his circumstances, demonstrating failure of the use-or-weigh component. The stem also establishes the required link between this inability and his cognitive impairment after practicable support has been provided. Presumption of capacity is the starting position, not the failed function. Supported decision-making must precede a finding of incapacity and has already occurred. Best-interests decision-making and consideration of the least restrictive alternative become relevant only after he has been found to lack capacity for this specific decision.

Reference: NICE, Decision-making and mental capacity (NG108), sections 1.1.53–1.1.75, 2018. https://www.nice.org.uk/guidance/NG108/chapter/recommendations