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Capacity assessment in acute delirium — SCE Acute Medicine MCQ

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ModeratePerioperative, Safety and End-of-Life CareCapacity assessment in acute deliriumSCE Acute Medicine

A 73-year-old man presents with postoperative deterioration, treatment refusal or advanced illness. Relevant history includes recent surgery, frailty or a governance issue. On assessment, physiology and communication context require senior decision-making. Investigations show fluctuating delirium prevents retention of information about pneumonia treatment. What would you advise this patient?

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Correct answer: C — Assess capacity decision-specifically and treat in best interests if capacity is lacking

The key discriminator is that fluctuating delirium prevents retention of information about pneumonia treatment, which makes Assess capacity decision-specifically and treat in best interests if capacity is lacking the single best answer. Offer safety-netted admission with shared decision-making is less appropriate because it does not address the dominant acute risk in the vignette; Explain CPR likelihood and make a shared DNACPR decision would fit a different presentation or later stage of care. Explain the need for urgent treatment despite uncertainty and Assess capacity for this specific decision are suboptimal because they would either delay time-critical treatment or follow the wrong acute pathway. Teaching point: SCE-style acute medicine questions usually test prioritisation using physiology, timing and a guideline-defined threshold, rather than isolated factual recall.

Reference: Mental Capacity Act 2005 Code of Practice; GMC guidance