1. Dennis is 90 years old, he has fallen over and needs an operation, the medical team states that his wife can consent on his behalf, if he is unable to.

2. False (without relevant LPA) Dennis’s wife would be unable to consent in this situation unless she held a valid court stamped Lasting Power of Attorney (LPA) for care and welfare. Next of Kin have no legal rights to consent on behalf of another adult if they have not been appointed as a legal attorney or as Court Deputy. However Next of Kin should always be consulted and fully involved with any decision making process; as in most cases they are likely to have expert personal knowledge which needs to be taken into consideration as part Of any Best Interest’s Decision Making

3. In hospitals the Mental Capacity Act only applies to decisions about major surgery.

4. False- The MCA applies to all decisions the big and the small, so the principles should always be upheld.

5. Because Frank is refusing medical treatment, he lacks capacity and decisions can be made on his behalf.

6. False, The first principle of the act is an assumption of capacity, people cannot be assumed to lack capacity purely on the basis of a decision which appears ‘unwise to others’ As such professionals would need to work with Frank to check whether or not he can Be supported to make this decision, if he is not then all the principles of the Best Interest's checklist must be applied. If this is likely to be contentious then the Court of Protection should be involved. courtofprotectionenquiries@hmcts.gsi.gov.uk Emergency applications Telephone: 0300 456 4600 Monday to Friday, 10am to 4pm Out-of-hours emergency applications Telephone: 020 7947 6000

7. When a person has dementia, they won’t have capacity so there is no need to assess their capacity.

8. False, The first principle of the act is a presumption of capacity; and while a diagnosis of dementia is likely to indicate difficulty with some decisions at some times, the act is very clear about decisions being both time and decision specific and people being appropriately supported to make their decisions wherever possible.

9. Jim tells you that you that he has an LPA for Personal Welfare for his wife Enid, he can consent to her medical treatment on her behalf.

10. If True, However Jim should be able to show professionals the LPA so that it can be checked that it is for Care and Welfare as opposed to finances, that it has a relevant Court Stamp, that Jim is named as the Attorney and that he can make decisions severelly rather than jointly with named others. Jim is obligated by the Office of The Public Guardian to share this information with professionals in such situations.

11. An MMSE has been completed, the person scored 8/30, therefore there is no need to assess their capacity.

12. FALSE An MMSE is a Mini Mental State Examination which is a tool that can be used to assess mental status or cognition. It is a helpful way of providing supporting information about difficulties with thought processes. However it is different to a mental capacity test which is about specific decisions at specific times. As such a low MMSE score will indicate difficulties but this alone should not be used to indicate a blanket lack of mental capacity, the principles of the act should still apply.

13. Best interests means what is safest for the person, their views and wishes are not relevant to what is in their best interests.

14. FALSE Best Interests means what is best for the individual taking into account all their individual views, opinions and aspirations as well as the opinions of those who know the individual well. Decision makers should holistically consider what the individual would have decided for themselves if they were able to make the decision. In some circumstances this may require weighing up both autonomy and safety and to determine any ‘magnetic factors’ such as a desire to live in ones own home. Where decisions are likely to be contentious, the Court of Protection may need to be consulted courtofprotectionenquiries@hmcts.gsi.gov.uk Emergency applications Telephone: 0300 456 4600 Monday to Friday, 10am to 4pm Out-of-hours emergency applications Telephone: 020 7947 6000

15. Francis has made an advanced decision to refuse a blood transfusion. The medical team should respect this decision even if they do not agree with it.

16. True The Mental Capacity Act (2005) made Advanced Decisions legally binding, but for them to be legally binding, they must be valid and applicable. An Advanced Decision can only be made by a person of 18yrs, when they had mental capacity to do so and were not being coerced or pressured by others. It should also be signed, dated and witnessed and should not have been superseded by a Lasting Power of Attorney. It must specify what treatment is to be declined, such as Francis declining a blood transfusion. Where an Advanced decision is to refuse life saving treatment, this should be specified and should make explicit that such a refusal be upheld ‘even if life is at risk’. There should be no grounds to believe that a change in circumstances since the Advanced Decision was made would have changed the decision being refused. Any refusal made will only apply in the circumstances that have been specified; and clinicians need to be informed that an Advanced Decision has been made

17. Mr. Davies has dementia, he is an in- patient in the hospital. Mr. Davies is confused and disorientated, the hospital can routinely prevent him from leaving.

18. False The hospital may be able to restrict someone under the Mental Capacity Act, but cannot routinely deprive someone of their liberty without due regard to the law. The difference between restrictions on liberty and deprivation of liberty is one of degree or intensity and depends on the type of measure imposed, its duration, effects and how it is implemented. This does not mean that a hospital cannot prevent someone from leaving, but it does mean that where such prevention deprives someone of their liberty and where they cannot consent to such an arrangement the individuals rights must be protected in law. This may mean an application under Deprivation of Liberty Safeguards, or there may be an authorised deprivation via the Mental Health Act or where a person is detained under criminal law.