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Capacity and refusal of life-saving treatment — SCE Acute Medicine MCQ

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HardPatient Safety and Risk ManagementCapacity and refusal of life-saving treatmentSCE Acute Medicine

A 46-year-old man with severe hyperkalaemia from AKI refuses IV treatment, saying he understands he could die but believes treatment conflicts with his values. He can explain the diagnosis, proposed treatment, risks of refusal and alternatives, and his decision is consistent over repeated discussions. He is not delirious or intoxicated. What would you advise?

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Correct answer: A — Respect the capacitous refusal while continuing supportive discussion

A capacitous adult can refuse life-saving treatment, even if clinicians consider the decision unwise. Capacity is decision-specific and requires understanding, retention, weighing and communication. Family members cannot override a capacitous refusal unless a valid legal framework applies. The pearl is that outcome severity does not determine capacity.

Reference: Mental Capacity Act 2005; GMC consent guidance