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Complex disability and best interests — DFSRH MCQ

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HardSpecial CircumstancesComplex disability and best interestsDFSRH

A 25-year-old with severe cognitive impairment cannot make a decision about menstrual suppression despite all practicable communication support. Carers request DMPA for easier hygiene. What is required?

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Correct answer: D — Use a least-restrictive best-interests process with her involvement

The best answer is “Use a least-restrictive best-interests process with her involvement”. When capacity for this specific decision is absent, the Mental Capacity Act requires a best-interests decision, not substituted consent from carers. The process must involve her as far as possible, consider past and present wishes, consult relevant people, compare benefits and burdens and choose the least restrictive effective option. Specialist, safeguarding or legal input may be needed for contested or high-impact decisions.

Reference: Mental Capacity Act 2005, sections 1 and 4: https://www.legislation.gov.uk/ukpga/2005/9/section/4