Case studies

All these case scenarios have been reproduced from the Mental Capacity Act 2005 Code of Practice and Making Decisions – A guide for people who work in health and social care (OPG 603). Both of these are available to download for free from the Office of the Public Guardian’s website.

Scenario 1: Assessing whether an impairment or disturbance is affecting someone's ability to make a decision

Mrs Collins is 82 and has had a stroke. This has weakened the left-hand side of her body. She is living in a house that has been the family home for years. Her son wants her to sell her house and live with him. Mrs Collins likes the idea, but her daughter does not. She thinks her mother will lose independence and her condition will get worse.

She talks to her mother's consultant to get information that will help stop the sale. But he says that although Mrs Collins is anxious about the physical effects the stroke has had on her body, it has not caused any mental impairment or affected her brain, so she still has capacity to make her own decision about selling her house.

Scenario 2: Treating everybody equally

Tom, a man with cerebral palsy, has slurred speech. Sometimes he also falls over for no obvious reason. One day Tom falls in the supermarket. Staff call an ambulance, even though he says he is fine. They think he may need treatment after his fall.

When the ambulance comes, the ambulance crew know they must not make assumptions about Tom's capacity to decide about treatment, based simply on his condition and the effects of his disability. They talk to him and find that he is capable of making healthcare decisions for himself.

Scenario 3A: Allowing people to make decisions that others think are unwise

As a result of a car accident a few years ago Margie is paralysed and also has brain damage. Margie has received significant compensation for her injuries. She wants to use part of the money on cosmetic surgery.

Her family agree that she understands the financial implications of spending a portion of the compensation on cosmetic surgery. However, they are concerned that she does not understand the risks that the procedure will involve. 

The cosmetic surgeon has had several consultations with Margie. She has made it clear that she understands the implications both physically and financially and is determined to have the surgery. She thinks it will increase her self esteem and confidence and that these benefits outweigh the potential risks.

The surgeon also asks a colleague to discuss the implications of the surgery with Margie. His colleague concludes that Margie has the capacity to make the decision and makes a note in the health records.

Scenario 3B: Allowing people to make decisions that others think are unwise

Mr Garvey is a 40-year-old man with a history of mental health problems. He sees a Community Psychiatric Nurse (CPN) regularly. Mr Garvey decides to spend £2,000 of his savings on a camper van to travel around Scotland for six months.

His CPN is concerned that it will be difficult to give Mr Garvey continuous support and treatment while travelling, and that his mental health might deteriorate as a result. However, having talked it through with his CPN, it is clear that Mr Garvey is fully aware of these concerns and has the capacity to make this particular decision. He has decided he would like to have a break and thinks this will be good for him.

Just because, in the CPN's opinion, continuity of care might be a wiser option, it should not be assumed that Mr Garvey lacks the capacity to make this decision for himself.

Scenario 3C: Allowing people to make decisions that others think are unwise

Peter is a 60-year-old man who is admitted to hospital for investigations for abdominal pains. Peter had a stroke two years ago and is extremely claustrophobic. His speech is slurred and difficult to understand and he gets a little confused when he is very tired. 

The medical staff want to do an abdominal CT scan on Peter but this will require him to lie flat in an enclosed space, something that Peter will not consider. He refuses to consent to the procedure. The potential implications of his decision are explained to Peter and, as it is clear that he understands what the doctors have explained, it is his right to decide not to have the CT scan.

He refuses to consent to the treatment, having weighed up the implications of his decision. Staff must respect his decision. Remember that a person is entitled to make an unwise decision.