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Capacity in depression — MCCQE Part 1 MCQ

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HardEthics & ProfessionalismCapacity in depressionMCCQE Part 1

A man with severe depression refuses hospital treatment for pneumonia. He accurately explains the illness, proposed treatment, alternatives and foreseeable consequences of refusal. His reasoning is consistent and not driven by delusion. What is the best conclusion?

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

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Correct answer: C — He may be capable; assess understanding and appreciation

Capacity is not determined by diagnosis or whether the clinician considers the choice wise. In Canadian treatment decisions, the core question is whether the patient can understand the relevant information and appreciate the reasonably foreseeable consequences of accepting or refusing the proposed care. Capacity is time-, context- and decision-specific. If he meets the applicable standard, his informed refusal is generally respected while clinicians treat remediable barriers, document the discussion, safety-net and continue to offer care.

Reference: CMPA, Is This Patient Capable of Consenting?, https://www.cmpa-acpm.ca/en/advice-publications/browse-articles/2011/is-this-patient-capable-of-consenting; Capacity Assessments, https://www.cmpa-acpm.ca/en/advice-publications/browse-articles/2020/capacity-assessments-understanding-the-challenges-for-physicians