NMC OSCE Mental Capacity & Professional Communication 1 — Questions and Answers
Question 1: The Mental Capacity Act 2005 is underpinned by five key principles. Which of the following correctly states the first principle?
- All adults are assumed to lack capacity until proven otherwise
- A person must be assumed to have capacity unless it is established that they lack it (Correct answer)
- Capacity must be formally assessed before any decision can be made
- Only doctors can assess mental capacity
Correct answer: A person must be assumed to have capacity unless it is established that they lack it
The first principle of the MCA 2005 is the presumption of capacity: every adult is assumed to have capacity unless it is established otherwise. This prevents unnecessary paternalism and respects individual autonomy.
Question 2: A patient with advanced dementia needs a tooth extraction. They cannot consent to the procedure. Under the MCA 2005, how should clinicians proceed?
- Ask the patient's next of kin to consent on their behalf
- Apply to the Court of Protection for a consent order
- Make a best interests decision following MCA principles, consulting relevant people (Correct answer)
- Refuse to proceed without valid consent from any source
Correct answer: Make a best interests decision following MCA principles, consulting relevant people
When an adult lacks capacity to consent, clinicians must make a best interests decision under the MCA 2005. This involves considering the patient's past and present wishes, values, and beliefs, and consulting those close to them (family, carers). Next of kin cannot legally consent on behalf of an adult — only the Court of Protection or a Lasting Power of Attorney (Health) can do so.
Question 3: What is a Lasting Power of Attorney (LPA) for Health and Welfare?
- A legal document allowing a person to manage someone else's bank account
- A legal document allowing a nominated person to make health and welfare decisions on behalf of someone who loses capacity (Correct answer)
- A court order to impose treatment against a patient's wishes
- A document signed by a doctor authorising emergency treatment
Correct answer: A legal document allowing a nominated person to make health and welfare decisions on behalf of someone who loses capacity
A Health and Welfare LPA is a legal document that allows a person (the donor) to appoint someone they trust (the attorney) to make decisions about their health and personal welfare if they lose mental capacity. The attorney can only act when the donor lacks capacity.
Question 4: Which of the following correctly describes the two-stage test for mental capacity assessment under the MCA 2005?
- Is the person over 16, and have they been diagnosed with a mental disorder?
- Does the person have an impairment of the mind or brain, AND does that impairment cause them to be unable to make the specific decision? (Correct answer)
- Is the person refusing treatment, and is the refusal harmful?
- Has a psychiatrist assessed them, and do they have a psychiatric diagnosis?
Correct answer: Does the person have an impairment of the mind or brain, AND does that impairment cause them to be unable to make the specific decision?
The MCA two-stage test asks: (1) Does the person have an impairment of, or disturbance in the functioning of, the mind or brain? (2) Does that impairment mean they cannot understand, retain, weigh, or communicate information about the decision? Both stages must be met.
Question 5: A patient with a learning disability is being consented for surgery. Which approach best supports their ability to make an informed decision?
- Use standard consent forms without modification
- Ask a family member to consent on their behalf without assessing the patient first
- Provide information in an accessible format (easy read, pictures) and allow extra time (Correct answer)
- Assume they lack capacity and proceed to best interests decision-making
Correct answer: Provide information in an accessible format (easy read, pictures) and allow extra time
The MCA 2005 requires that all practicable steps are taken to support a person to make their own decision before concluding they lack capacity. For someone with a learning disability, this means providing accessible information, using communication aids, and allowing sufficient time.
Question 6: A patient has an advance decision to refuse treatment (ADRT) that specifically refuses blood transfusion in all circumstances. The patient is now unconscious and requires a transfusion to survive. What should the clinical team do?
- Administer the transfusion as the patient cannot currently communicate their wishes
- Follow the ADRT if it is valid, applicable, and made when the patient had capacity (Correct answer)
- Ask the family if they agree with the patient's earlier decision
- Seek a court order to override the ADRT
Correct answer: Follow the ADRT if it is valid, applicable, and made when the patient had capacity
A valid and applicable ADRT is legally binding under the MCA 2005. If the document specifically refuses treatment that is now being considered, is signed, witnessed, and made when the patient had capacity, the clinical team must respect it, even if it results in the patient's death.
NMC OSCE Mental Capacity & Professional Communication 1
The Mental Capacity Act 2005 is underpinned by five key principles.
Which of the following correctly states the first principle?