In what circumstances should I consider involving a legal expert when managing a patient with capacity issues?

Consider involving a legal expert when managing a patient with capacity issues in the following circumstances:

• When there is uncertainty or dispute about the patient's capacity to make a specific decision, especially if the assessment is complex or contested, as capacity must be decision-specific and based on the Mental Capacity Act 2005 legal test ¹.
• If the patient lacks capacity and there is no clear advance decision or lasting power of attorney in place, and decisions about care, treatment, or finances need to be made, legal advice may be required to ensure compliance with the Mental Capacity Act 2005 ¹.
• When decisions involve refusal of life-sustaining treatment or other serious medical interventions, as advance decisions to refuse treatment must meet strict legal criteria and may require legal scrutiny ¹.
• If there is concern about undue influence, coercion, or pressure affecting the patient's decision-making, since lack of capacity cannot be established solely on behaviour or condition but must consider these factors carefully ¹.
• When a Court of Protection deputy or other legal appointee is involved or needs to be appointed to make decisions on behalf of the patient who lacks capacity ¹.
• Where there are disagreements among family, carers, or professionals about the best interests decisions or the interpretation of the patient's wishes and preferences, legal input can help resolve conflicts and ensure lawful decision-making ¹.

In all cases, thorough, proportionate capacity assessments should be conducted first, with all practicable steps taken to support the patient’s decision-making before involving legal experts ¹.