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Capacity might be mentioned in your Med School interview, because it’s an important issue in Medicine. While you tackle your interview prep, take the time to thoroughly understand this hot topic and consider how you can apply the four pillars of ethics when thinking about issues of capacity.

What Is Capacity?

In Medicine, capacity is the ability to give consent. It relies on the patient being able to understand information and use this information to make a decision.

Capacity is important because a Doctor needs to know if a patient is capable of giving consent to their own medical treatment.

How Is Capacity Assessed?

Patients over the age of 18 are assumed to have capacity unless this is proven otherwise.

In order to have capacity, a person must be able to:

  • Understand the information they are given
  • Remember the information
  • Use the information (weighing up benefits and risks, etc) to make a decision
  • Communicate their decision

How Does Assessing Capacity Work?

A person’s capacity can change over time, so it should be assessed at the time when consent is needed.

Capacity is usually assessed by the medical professional who is recommending the treatment and/or carrying it out. If they determine that the patient has capacity to consent, the patient’s decision will be accepted.

Even if they lose capacity at a later stage, the patient’s decision that was made when able to consent will continue to be respected.

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Personal Beliefs And Capacity

If someone wants to make a particular decision that others may find irrational or illogical, this doesn’t necessarily mean that the person lacks capacity – as long as they fully understand their situation and the consequences of their actions.

For example, someone might choose to refuse a blood transfusion because it goes against their religious beliefs.

In contrast, if someone is in a severe stage of anorexia and refuses treatment because they believe there is nothing wrong with them, they would be considered to lack capacity. This is because the patient doesn’t understand the realities of their situation.

What Happens If Someone Lacks Capacity?

A person may lack capacity, and therefore be deemed unable to give consent, if their mind is impaired in some way.

This could include:

  • A mental health condition such as schizophrenia or bipolar disorder
  • Dementia
  • A severe learning disability
  • Brain damage
  • A condition that causes confusion, drowsiness or loss of consciousness
  • Intoxication due to alcohol or drugs

If a patient lacks capacity to make a decision, the Doctor is expected to act in the best interests of the patient. For instance, would it be safe to delay treatment until a point when the patient has regained capacity? Could any close relatives or friends offer an insight into the patient’s moral or religious beliefs that should be taken into account?

Someone who has a permanent lack of capacity may have a medical proxy who is able to make decisions for them, or they may have an advanced directive in place. If there is nobody suitable at hand to help the patient make decisions, an independent mental capacity advocate should be consulted.

If there is a serious dispute over the best interests of a patient who is lacking capacity, medical professionals can refer the case to the Court of Protection for a ruling. This legal body oversees the operation of the Mental Capacity Act.

What Happens If There Are Changes In Capacity?

A person’s capacity to consent can change. In certain cases, a patient might be capable of making some decisions but not others, or their capacity may come and go. For example, a person with a condition such as schizophrenia may have periods where they have capacity and periods where they don’t.

If a person knows that their capacity to consent could change, they can draw up a legally binding advance decision. This is also sometimes known as a ‘living will’ and it sets out any medical treatments that they would choose to refuse.

They can also choose to give someone, such as a family member, lasting power of attorney to make important decisions on their behalf if they lack capacity in the future.

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