Practical implications of overlapping mental capacity assessments

Mental capacity was described by Lord Donaldson in Re T (Adult: Refusal of Treatment) [1992] as the key to a person's autonomy. Where a person has capacity to make a decision we are bound by their decision; where the presumption of capacity is rebutted, then we can act or make decisions for that person in their best interests.

Section 5 of the Mental Capacity Act 2005 gives nurses general authority to act or make decisions in relation to a person's care and treatment where:

Section 5 of the 2005 Act provides for a person lacking capacity in relation to a matter, highlighting that matters of capacity are decision or matter specific. When applying this to the care or treatment of a person, there will often be several matters to be considered and subject to a mental capacity assessment, including:

The challenge for the assessor is whether these matters have to be viewed as individual decisions distinct and unconnected to the other matter being assessed or whether there is an interplay between these matters that can influence the outcome of a capacity assessment.