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 14: Getting the location and timing right

Luke, a young man, was seriously injured in a road traffic accident and suffered permanent brain damage. He has been in hospital several months, and has made good progress, but he gets very frustrated at his inability to concentrate or do things for himself. 

Luke now needs surgical treatment on his leg. During the early morning ward round, the surgeon tries to explain what is involved in the operation. She asks Luke to sign a consent form, but he gets angry and says he doesn't want to talk about it. His key nurse knows that Luke becomes more alert and capable later in the day.

After lunch, she asks him if he would like to discuss the operation again. She also knows that he responds better one-to-one than in a group. So she takes Luke into a private room and repeats the information that the surgeon gave him earlier. He understands why the treatment is needed, what is involved and the likely consequences. 

Therefore, Luke has the capacity to make a decision about the operation.

Scenario 15: Overall assessment of capacity

Mr Leslie has learning disabilities and has developed an irregular heartbeat. He has been prescribed medication for this, but is anxious about having regular blood tests to check his medication levels.

His doctor gives him a leaflet to explain: the reason for the tests what a blood test involves the risks in having or not having the tests, and that he has the right to decide whether or not to have the test. The leaflet uses simple language and photographs to explain these things.

Mr Leslie's carer helps him read the leaflet over the next few days, and checks that he understands it. Mr Leslie goes back to tell the doctor that, even though he is scared of needles, he will agree to the blood tests so that he can get the right medication. He is able to pick out the equipment needed to do the blood test.

So the doctor concludes that Mr Leslie can understand, retain and use the relevant information and therefore has the capacity to make the decision to have the test.

Scenario 16: Assessing a person's ability to retain information

Walter, an elderly man, is diagnosed with dementia and has problems remembering things in the short term. He can't always remember his great-grandchildren's names, but he recognises them when they come to visit. He can also pick them out on photographs.

Walter would like to buy premium bonds (a type of financial investment) for each of his great-grandchildren. He asks his solicitor to make the arrangements. After assessing his capacity to make financial decisions, the solicitor is satisfied that Walter has capacity to make this decision, despite his short-term memory problems.

Scenario 17: Recording the assessment

Ridwaan has dementia and lives in a residential care home. Like many people with dementia his mental capacity fluctuates. On most days he can make all the basic decisions about daily living such as washing, eating and drinking etc. 

However, sometimes he lacks capacity to make the most basic of decisions, such as what to eat.

On these occasions, a possible entry in the care records could be: “At lunch time today, Ridwaan lacked capacity to decide what to eat, so a decision about this was made in his best interests. At each mealtime we will assess his capacity to decide what he wants to eat. If Ridwaan has capacity to make this decision at any point he will decide what to eat”.

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