Exam Pass Notes

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The Core MCA Principles

• Start from the presumption that a person has capacity unless evidence suggests otherwise.
• Offer practical support and adjustments to help the person make the decision before concluding they lack capacity.
• An unwise or unconventional decision does not by itself indicate incapacity.
• If someone lacks capacity for a particular decision, act in that person's best interests.
• When choosing an option, pick the one that restricts the person's rights and freedom least while meeting the need.

Dental Nurse Role

• Dental nurses rarely make formal capacity determinations for treatment led by a dentist.
• They should identify barriers to communication, signs of distress or undue influence, fluctuating understanding, and practical measures that aid decision-making.
• Observations and actions should be recorded factually and communicated to the dentist or senior clinician, escalating concerns when necessary.
• Do not assume a relative or carer has legal authority to consent on the patient's behalf; verify authority where required.

Legal Authority and Escalation

• Capacity is decision-specific and time-specific; it must be assessed in relation to the particular choice and moment.
• Check legal documents such as lasting powers of attorney, court-appointed deputies, guardianship orders, and advance decisions before accepting someone else’s authority.
• Legal arrangements differ in Scotland and Northern Ireland compared with England and Wales; follow the appropriate jurisdictional rules.
• If authority is unclear, there is disagreement, or the patient is distressed or at risk, seek senior review and consider safeguarding procedures.