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 8A: Getting help with assessing capacity

Ms Dodd suffered brain damage in a road accident and is unable to speak. At first, her family thought she was not able to make decisions. But they soon discovered that she could choose by pointing at things, such as the clothes she wants to wear or the food she prefers.

Her behaviour also indicates that she enjoys attending a day centre, but she refuses to go swimming. Her carers have assessed her as having capacity to make these decisions. Ms Dodd needs hospital treatment but she gets distressed when away from home.

Her mother feels that Ms Dodd is refusing treatment by her behaviour, but her father thinks she lacks capacity to say no to treatment that could improve her condition. The clinician who is proposing the treatment will have to assess Ms Dodd's capacity to consent.He gets help from a member of staff at the day centre who knows Ms Dodd's communication well and also discusses things with her parents. 

Over several meetings the clinician explains the treatment options to Ms Dodd with the help of the staff member. The final decision about Ms Dodd's capacity rests with the clinician, but he will need to use information from the staff member and others who know Ms Dodd well to make this assessment.

Scenario 8B: Getting help with assessing capacity

Claude lives in a care home but his dementia is causing him great distress. Fellow residents are also upset by his actions, even though they know he is ill. Does he have capacity to consent to move to a new home where staff may be able to offer him more support?

This is a decision where the views of several professionals, including his GP, the consultant psychogeriatrician, the community nurse who sees him regularly and the home manager, will be required. The care manager is responsible for co-ordinating the assessment of Claude's capacity to make this decision. The care manager will also find it helpful to talk to Denise, Claude's great-niece, who has known him for many years and still visits him occasionally.

Scenario 9: Providing relevant information

Mrs Thomas has Alzheimer's disease and lives in a care home. She enjoys taking part in the activities provided at the home. Today there is a choice between going to a flower show, attending her usual pottery class or watching a DVD. Although she has the capacity to choose, having to decide is making her anxious.

The care assistant carefully explains the different options. She tells Mrs Thomas about the DVD she could watch, but Mrs Thomas doesn't like the sound of it. The care assistant shows her a leaflet about the flower show. She explains the plans for the day, where the show is being held and how long it will take to get there in the mini-van. She has to repeat this information several times, as Mrs Thomas keeps asking whether they will be back in time for supper. She also tells Mrs Thomas that one of her friends is going on the trip.

At first, Mrs Thomas is reluctant to disturb her usual routine. But the care assistant reassures her she will not lose her place at pottery if she misses a class. With this information, Mrs Thomas can therefore choose whether or not to go on the day trip.

Scenario 10A: Taking steps to help people make decisions for themselves

Mr Jackson is brought into hospital following a traffic accident. He is conscious but in shock. He cannot speak and is clearly in distress, making noises and gestures. From his behaviour, hospital staff conclude that Mr Jackson currently lacks the capacity to make decisions about treatment for his injuries, and they give him urgent treatment.

They hope that after he has recovered from the shock they can use an advocate to help explain things to him. However, one of the nurses thinks she recognises some of his gestures as sign language, and tries signing to him. Mr Jackson immediately becomes calmer, and the doctors realise that he can communicate in sign language. He can also answer some written questions about his injuries.

The hospital brings in a qualified sign-language interpreter and concludes that Mr Jackson has the capacity to make decisions about any further treatment.

Scenario 10B: Making the most of technology

Ms Patel has an autistic spectrum disorder. Her family and care staff find it difficult to communicate with her. She refuses to make eye contact, and gets very upset and angry when her carers try to encourage her to speak. One member of staff notices that Ms Patel is interested in the computer equipment.

He shows her how to use the keyboard, and they are able to have a conversation using the computer. An IT specialist works with her to make sure she can make the most of her computing skills to communicate her feelings and decisions.