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Capacity and refusal — DipIMC MCQ

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ModerateScene Safety and GovernanceCapacity and refusalDipIMC

A 45-year-old man with chest pain refuses transport despite an ECG showing ST elevation. He is alert, understands the information, can weigh consequences and communicates a consistent choice. What is the most appropriate immediate action?

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

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Correct answer: B — Assess and document capacity, explain risks, seek senior advice and record the refusal carefully

A capacitous adult can refuse treatment, even if the decision appears unwise. The clinician should assess capacity, explain material risks, seek support where appropriate and document the discussion and safety-netting. Relatives cannot override a capacitous adult. The pearl is that respecting autonomy requires excellent communication, not abandonment.

Reference: JRCALC Guidelines 2025; Mental Capacity Act 2005