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Mental Capacity Act — DFSRH MCQ

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HardMental Capacity ActDFSRH

A 31-year-old woman in England with a moderate learning disability is scheduled for laparoscopic cystectomy for a symptomatic benign ovarian dermoid. Using accessible information and communication support, she demonstrates capacity to consent to the cystectomy. However, after repeated specialist contraceptive counselling, she cannot understand or weigh the irreversible loss of fertility associated with bilateral salpingectomy and is assessed as lacking capacity specifically for that decision. She has repeatedly expressed that she does not want a pregnancy and currently accepts depot medroxyprogesterone acetate, which remains medically suitable. Her mother is the registered health and welfare attorney and requests that bilateral salpingectomy be performed during the same anaesthetic. The fallopian tubes are normal, there is no relevant cancer predisposition, and the sole purpose of salpingectomy would be permanent contraception. A multidisciplinary best-interests meeting, including the patient as far as possible, supports effective contraception and records no disagreement or safeguarding concern. Which is the most appropriate management of the request for salpingectomy?

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

Reveal the answer and explanation

Correct answer: C — Perform cystectomy alone, continue reversible contraception, and seek a Court of Protection determination before any sterilisation

Explanation lettering: C = shown as A · E = shown as B · D = shown as C · B = shown as D · A = shown as E

Capacity is decision-specific: her valid consent to cystectomy neither establishes capacity for, nor authorises, the additional salpingectomy. Because the normal tubes would be removed solely to provide permanent contraception, this is non-therapeutic sterilisation. The Mental Capacity Act Code of Practice identifies proposed non-therapeutic sterilisation of a person lacking capacity as a category that should be brought before the Court of Protection. Agreement among clinicians and relatives, a favourable best-interests assessment, previous wishes to avoid pregnancy and the existence of a health and welfare attorney do not remove that requirement. A is incorrect because consent to one operation cannot be extended to a materially different procedure, although her wishes remain relevant to best interests. B is a plausible route for many treatments delivered under the Mental Capacity Act, but an attorney cannot replace the required court scrutiny for non-therapeutic sterilisation. C is incorrect because an IMCA supports and represents the person rather than authorising treatment; moreover, mandatory IMCA involvement for serious medical treatment generally applies when no appropriate person is available for consultation. E is too categorical: lack of capacity does not create an absolute prohibition, but the court must determine whether sterilisation is in her best interests. The cystectomy can therefore proceed separately, with suitable reversible contraception maintained while any court application is considered.

Reference: Mental Capacity Act 2005 Code of Practice (First published 2007; GOV.UK publication page updated 14 October 2020) — https://www.gov.uk/government/uploads/system/uploads/attachment_data/file/497253/Mental-capacity-act-code-of-practice.pdf Mental Capacity Act 2005 Code of Practice (First published 2007; GOV.UK publication page updated 14 October 2020) — https://www.gov.uk/government/uploads/system/uploads/attachment_data/file/497253/Mental-capacity-act-code-of-practice.pdf FSRH Guideline: Progestogen-only Injectable Contraception (December 2014; amended 11 July 2023) — https://www.fsrh.org/Common/Uploaded%20files/documents/progestogen-only-injectable-december-2014-amended-11july2023.pdf