skip to main content

Unwise Decision Principle — MRCPsych Paper B MCQ

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

EasyMental Health LawUnwise Decision PrincipleMRCPsych Paper B

In England and Wales, a 45-year-old voluntary outpatient with a moderate depressive episode is offered antidepressant medication. She is not subject to compulsory treatment powers under the Mental Health Act 1983. She understands and retains the relevant information, uses and weighs it against her own values, and communicates a clear refusal. Her psychiatrist strongly disagrees with her choice and believes treatment would benefit her. Which statutory principle of the Mental Capacity Act 2005 most directly prevents this disagreement from being used to conclude that she lacks capacity?

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

Reveal the answer and explanation

Correct answer: B — A person is not unable to decide merely because the decision appears ill-advised

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

D is correct. Section 1(4) of the Mental Capacity Act 2005 provides that a person must not be treated as unable to decide merely because the decision is unwise. NICE NG108 similarly states that perceived risk or lack of wisdom must not be used to infer incapacity. She demonstrates all four functional abilities, so disagreement with her chosen outcome is irrelevant. A is a true starting presumption but is less direct because capacity has already been assessed. C requires practicable support before concluding that a person is unable to decide; no unmet support need is described. B and E govern acts or decisions for a person who lacks capacity and cannot justify overriding this capacitous refusal.

Reference: NICE guideline NG108, Decision-making and mental capacity, recommendation 1.1.69, 2018 — https://www.nice.org.uk/guidance/ng108/chapter/recommendations