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MCA Treatment Decision Authority — MRCPsych Paper B MCQ

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ModerateMental Health LawMCA Treatment Decision AuthorityMRCPsych Paper B

An adult in England lacks capacity to consent to proposed serious medical treatment. There is no valid and applicable advance decision, health and welfare attorney or court-appointed deputy with relevant authority. No family member or friend is available or appropriate to consult. The situation is not an emergency, there is no unresolved dispute, and the proposed treatment is not one requiring determination by the Court of Protection. Under the Mental Capacity Act 2005, who is the decision-maker?

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Correct answer: B — The clinician responsible for the treatment, following a best-interests process and consideration of an instructed IMCA's report

The clinician responsible for providing the treatment is normally the MCA decision-maker and must determine whether treatment is in the patient's best interests. Because this is serious medical treatment and there is nobody appropriate to consult other than paid staff, the responsible NHS body must instruct an IMCA. The IMCA represents the patient and provides a report, but does not give consent or make the final decision. Relatives have no general power of substitute consent unless appointed as a relevant health and welfare attorney or deputy. Hospital managers do not acquire decision-making authority merely through organisational responsibility. The Court of Protection determines specified particularly serious cases and unresolved disputes, but serious medical treatment does not invariably require judicial authorisation.

Reference: Mental Capacity Act 2005 Code of Practice, Chapter 5 paragraphs 5.8–5.12 and Chapter 10 paragraphs 10.42–10.48, 2007: https://www.gov.uk/government/uploads/system/uploads/attachment_data/file/497253/Mental-capacity-act-code-of-practice.pdf