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Best Interests Framework — MRCPsych Paper B MCQ

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ModerateMental Health LawBest Interests FrameworkMRCPsych Paper B

An 80-year-old man in England has severe dementia. After all practicable support has been provided, he is assessed as lacking capacity specifically to decide where he should live. There is no health and welfare attorney or court-appointed deputy. His daughter wants him to enter one care home, while the multidisciplinary team favours another. Under the Mental Capacity Act 2005, what approach should the relevant decision-maker take?

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Correct answer: E — Apply the section 4 best-interests process, involving him and considering his wishes, beliefs, values and consultees' views

The correct answer is E. Capacity is decision-specific, and once the man has been properly assessed as lacking capacity to decide where he should live, the relevant decision-maker must apply the section 4 best-interests framework. This includes involving him as far as possible, considering all relevant circumstances, and establishing his past and present wishes and feelings, beliefs and values. The daughter and multidisciplinary team should be consulted, but neither party's preference is automatically decisive. The least restrictive alternative is an important statutory principle, but it cannot replace the full best-interests assessment, so C is incomplete. A and D incorrectly give one party's view determinative status. A Court of Protection application may be appropriate for a serious dispute that cannot otherwise be resolved, but it is not required for every disagreement, making E incorrect.

Reference: GOV.UK, Making decisions: a guide for people who work in health and social care, sections 6–7 (current web version accessed 2026), https://www.gov.uk/government/publications/health-and-social-care-workers-mental-capacity-act-decisions/making-decisions-about-your-health-welfare-or-finances