Assessment of mental capacity
This first step involves the patient having their mental capacity assessed in accordance with the Mental Capacity Act.
In order to be considered as having capacity to make a particular decision a patient should be able to:
- Understand information relevant to the decision.
- Remember the information long enough to make the decision.
- Weigh up the information relevant to the decision.
- Communicate their decision.
If a patient is assessed as having the mental capacity to make decisions for themselves, those decisions must be respected. Every patient has the right to choose not to take their medication, for any reason, even if this would be detrimental to their health.
However, where a patient is identified as lacking capacity then their decision to refuse medication may not be justified. A 'best interests' meeting should take place between all relevant parties in order to identify appropriate courses of action. Just because a patient does not have the mental capacity to make decisions does not mean that their reasons for refusal of medication are invalid or that covert administration is automatically justified.
In England and Wales family members of relatives assessed as not having capacity, do not automatically have the legal right to provide consent to treatment on behalf of the patient. Only the prior registration of lasting Powers of Attorney can provide a legal basis for making decisions on a relative's behalf.