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 4: Assessing a person's capacity to make decisions

When planning for her retirement, Mrs Arnold made and registered a Lasting Power of Attorney (LPA) – a legal process that would allow her son to manage her property and financial affairs if she ever lacked capacity to manage them herself.

She has now been diagnosed with dementia, and her son is worried that she is becoming confused about money. Her son must assume that his mother has capacity to manage her affairs. Then he must consider each of Mrs Arnold's financial decisions as she makes them, giving her any help and support she needs to make these decisions herself.

Mrs Arnold's son goes shopping with her, and he sees she is quite capable of finding goods and making sure she gets the correct change. But when she needs to make decisions about her investments, Mrs Arnold gets confused – even though she has made such decisions in the past. She still doesn't understand after her son explains the different options.

Her son concludes that she has capacity to deal with everyday financial matters but not more difficult affairs at this time. Therefore, he is able to use the LPA for the difficult financial decisions his mother can't make. But Mrs Arnold can continue to deal with her other affairs for as long as she has capacity to do so.

Scenario 5: Excluded decisions

Lynette has dementia and is often very confused. She lives in a care home where a number of her day-to-day decisions are made for her. She has started a relationship with Harry, another resident, and staff think that they may be sleeping together.

Lynette's son, Mark, is unhappy about this development and tells staff that his mother is being taken advantage of, as she does not have the capacity to consent to this relationship.

Staff are unwilling to intervene as Lynette and Harry seem very fond of each other.

Scenario 6: Involving other people

Michael had a stroke 3 years ago. He has been unwell and is now in hospital. The doctor wishes to undertake further tests involving a general anaesthetic. The doctor discusses the procedure with Michael who becomes anxious and repeatedly asks why he needs an anaesthetic.

This is not an emergency but the doctor feels that Michael may lack capacity to consent as he does not seem to be able to understand and remember what the doctor is saying. So the doctor consults Michael's wife who explains that ever since the stroke Michael gets anxious when he is away from home and the people and things he is familiar with.

She tells the doctor that it would help if she was there when the doctor explained the tests to Michael as she can reassure him and explain things to him. The doctor discusses the tests again with Michael when his wife is present. Michael is at first reluctant to agree to the anaesthetic but his wife explains she will be there when he wakes up and that he will not have to stay in the hospital overnight.

With the help of his wife, Michael understands what the doctor is saying and is able to make a decision and give his consent to the tests.

Scenario 7A: Getting a professional opinion

Mr Elliott is 87 years old and lives alone. He has poor short-term memory, and he often forgets to eat. He also sometimes neglects his personal hygiene.

His daughter talks to him about the possibility of moving into residential care. She decides that he understands the reasons for her concerns as well as the risks of continuing to live alone and, having weighed these up, he has the capacity to decide to stay at home and accept the consequences.

Two months later, Mr Elliott has a fall and breaks his leg. While being treated in hospital, he becomes confused and depressed. He says he wants to go home, but the staff think that the deterioration in his mental health has affected his capacity to make this decision at this time.

They think he cannot understand the consequences or weigh up the risks he faces if he goes home. They refer him to a specialist in old age psychiatry, who assesses whether his mental health is affecting his capacity to make this decision. The staff will then use the specialist's opinion to help their assessment of Mr Elliott's capacity.

Scenario 7B: Involving professional opinion

Ms Ledger is a young woman with learning disabilities and some autistic spectrum disorders. Recently she began a sexual relationship with a much older man, who is trying to persuade her to move in with him and come off the pill.

There are rumours that he has been violent towards her and has taken her bankbook. Ms Ledger boasts about the relationship to her friends. But she has admitted to her key worker that she is sometimes afraid of the man. Staff at her sheltered accommodation decide to make a referral under the local adult protection procedures.

They arrange for a clinical psychologist to assess Ms Ledger's understanding of the relationship and her capacity to consent to it.