Exam Pass Notes

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Key Takeaways

• The Mental Capacity Act 2005 applies in England and Wales to people aged 16 and over and covers decision-specific assessments at particular times.
• Start by assuming capacity and offer practical support to help the person make their own decision where possible.
• Makes and choices that seem unwise do not, by themselves, indicate lack of capacity.
• When someone lacks capacity for a decision, act in their best interests and choose the least restrictive option that meets the need.
• Pharmacy teams must recognise when to escalate to a pharmacist, prescriber, wider care team, or to consider another legal route.

Capacity and Support

• Use the two-stage test: first identify an impairment or disturbance of the mind or brain; then decide whether that impairment prevents this specific decision now.
• Check the four functional abilities: can the person understand, retain, use or weigh relevant information, and communicate their decision?
• Support first: try plain language, a quieter setting, written or visual aids, different timing, or communication assistance before deciding the person lacks capacity.
• Remember fluctuation: capacity can vary. Illness, medicines, pain, delirium or intoxication may temporarily affect decision-making.

Best Interests and Legal Tools

• Best interests is person-centred: consider the person's wishes, feelings, beliefs and values, and consult relevant others when appropriate.
• Choose the least restrictive option: meet the identified need while interfering as little as possible with the person's rights and freedoms.
• Know the difference: an advance statement records preferences but is not legally binding; a valid and applicable advance decision to refuse treatment can be binding.
• Check authority carefully: a health and welfare lasting power of attorney only applies when the person lacks capacity and only within the attorney's authorised scope.

Pharmacy Practice

• MCA issues may arise: consider consent for services, medicine counselling, refusal of treatment, handing over medicines or information to relatives or carers, and sharing information with other professionals.
• Do not rush legal judgements at the counter: identify concerns, provide support, record decisions and reasons clearly, and escalate when necessary.
• Know the limits of this course: Scotland and Northern Ireland use different legal frameworks, and the MCA does not apply to under 16s.
• Use professional standards too: apply person-centred care, informed consent, effective communication and professional judgement alongside the MCA.