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Valid consent and capacity — ORE Part 1 MCQ

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HardDental Public Health, Ethics, Law and Infection ControlValid consent and capacityORE Part 1

An 82-year-old with mild dementia attends with pain from an unrestorable molar. Today he understands the diagnosis, can weigh extraction versus no treatment, asks relevant questions, and communicates a consistent choice to have the tooth extracted. His daughter disagrees and asks the dentist to remove a different tooth instead. What is the most appropriate treatment?

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Correct answer: B — Respect the patient's capacitous decision after providing appropriate information

The Mental Capacity Act 2005 requires assessment of functional capacity, not diagnosis. This patient demonstrates all four required capacities: understanding diagnosis, retaining information, weighing extraction against no treatment, and communicating a consistent choice. Dementia diagnosis alone does not negate capacity for a specific decision. Option B is correct: the patient's capacitous decision must be respected. Option C wrongly assumes dementia negates capacity. Option A ignores the consent requirement. Option E inappropriately invokes court involvement when capacity is clearly present. Option D violates the requirement that only the capacitous patient (or, if genuinely incapacitous, an appropriate surrogate under best-interests law) can consent. The daughter's disagreement does not override a capacitous decision and does not justify treating a different tooth.

Reference: Mental Capacity Act 2005; Mental capacity assessment in the multi-professional real world—qualitative study (2024); The Mental Capacity Act 2005: Considerations for obtaining consent for dental treatment (2017). https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11190650/