The NHS definition of capacity is “the ability to use and understand information to make a decision, and communicate any decision made.” This is very similar to competence, which is the patient’s ability to understand provided information and make a rational decision based on this by themselves. The only difference is that competence is used more in a legal setting, while capacity is used in a medical setting when making decisions about treatment. In order for a patient to have capacity they must be able to:
Only when these four requirements are met does a patient have capacity to make their own decisions. Most people are assumed to have capacity, including those with learning disabilities and dementia etc. until they are proven otherwise. For patients with these conditions, all attempts should be made in order to ensure that they understand all information relayed to them. For example, using simple language and writing information down for the patient to help their memory.
In cases where decisions are made when a person has capacity, and then capacity is lost, the original wishes of the patient are carried out. If the patient does not have capacity, they may appoint someone to make informed decisions for them (through lasting power of attorney), else the doctor must do whatever is in the patient’s best interests. However, in cases where there is serious questioning or debate about the best interests of someone without capacity, then this can be referred to the court of protection for further ruling.
Questions that involve the concept of capacity are usually centred around a case, and it is therefore important to carefully consider all information surrounding a case before coming to an informed decision. These questions are generally also centred around medical ethics, so be sure to include the four principles of medical ethics when answering these questions. All of the ethical principles are applicable here: autonomy when considering the patient’s wishes, beneficence and non-maleficence in the doctor’s decisions, and justice in ensuring that all patients receive access to the same treatments. As with all questions surrounding medical ethics, the best way to structure an answer is by using the four principles to lay out the main points for your argument, and then expand on each one throughout the answer. This ensures that you are considering all aspects and coming to an informed decision. When looking at the issue of capacity in a specific case, it is important to use your common sense and adapt readily to the situation given to you, as every case is different and can be looked at in a different way.
You can mention capacity in a given case in order to direct the conversation to focus more on ethics, if this is what you are more comfortable with. This technique is extremely effective and when utilised correctly, can manipulate the interview so that it plays to your strengths.
Direct questions may also be asked about capacity, but these will almost always be as part of a medical or ethical case.
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