Capacity & advance care planning flashcards
7 high-yield MRCP Part 1 cards from the Intellect Medicos Geriatrics & Palliative Care course. Try to answer each question before you open it — then study them properly with spaced repetition, which brings each card back just before you would forget it.
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Under the Mental Capacity Act 2005, what is the starting assumption about an adult's capacity?
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A person must be assumed to have capacity unless it is established that they lack it.
Why? This is the first of the five MCA principles. Others: help people decide, unwise decisions are allowed, best interests, least restrictive option.
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Under the Mental Capacity Act, a person is unable to make a decision if they cannot do which four things?
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Understand the information, retain it, use or weigh it, and communicate the decision.
Why? Failing any one of these, because of an impairment of mind or brain, means the person lacks capacity for that decision.
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Mental capacity is ______.
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decision-specific and time-specific
Why? A person may lack capacity for a complex decision but not a simple one, or lack it during delirium and regain it later.
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What must an advance decision refusing life-sustaining treatment include to be valid?
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It must be in writing, signed and witnessed, and state that it applies even if life is at risk.
Why? These formalities apply only to refusals of life-sustaining treatment; other advance refusals can be verbal.
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Which type of Lasting Power of Attorney can make decisions about medical treatment, and when can it be used?
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A Health and Welfare LPA — only once the person lacks capacity for that decision.
Why? It covers refusing life-sustaining treatment only if the LPA document expressly gives that power. A Property and Financial Affairs LPA cannot make medical decisions.
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Should a patient with capacity be told about a DNACPR decision made because CPR would not work?
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Yes — they should be informed and the decision discussed, unless this would cause them physical or psychological harm.
Why? The Tracey judgment (2014) found a duty to consult. Doctors need not offer CPR that will not work, but must not hide the decision.
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Does a DNACPR decision mean other treatments should be withheld?
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No — it applies only to CPR. All other appropriate treatment (antibiotics, fluids, escalation) continues.
Why? Wider ceilings of treatment must be discussed and recorded separately, e.g. on a ReSPECT form.