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Decision-making capacity — MCCQE Part 1 MCQ

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HardEthics & ProfessionalismDecision-making capacityMCCQE Part 1

A 79-year-old woman with mild dementia is admitted with pneumonia and refuses antibiotics. She can describe pneumonia, explain that refusing antibiotics could lead to death, compare options, and consistently states antibiotics conflict with her goals. What should you tell this patient?

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

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Correct answer: B — Respect the refusal as the principal mechanism

Capacity is decision-specific and depends on understanding, appreciation, reasoning, and communication of a choice. Mild dementia does not automatically remove capacity. A substitute decision-maker is used when the patient lacks capacity for the decision. Covert treatment would violate autonomy and legal standards unless exceptional emergency incapacity criteria applied.

Reference: https://mcc.ca/objectives/medical-experts/