The Mental Capacity Act (2005) establishes that individuals are presumed to have capacity unless proven otherwise and that all reasonable efforts must be made to assist them in decision-making. It emphasizes that making an unwise decision does not equate to a lack of capacity, which can only be suggested by mental impairment. The act outlines a four-test assessment for determining capacity, focusing on understanding, retention, weighing information, and communication of decisions.

1. Support sheet 12
Mental Capacity Act (2005)
1. A person must be assumed to have capacity unless it is established that they lack
capacity.
2. A person is not to be treated as unable to make a decision unless all practicable steps
to help him to do so have been taken without success.
3. A person is not to be treated as unable to make a decision merely because he makes
an unwise decision.
4. An act done or decision made, under this Act for or on behalf of a person who lacks
capacity must be done, or made, in his best interests.
5. Before the act is done, or the decision is made, regard must be had to whether the
purpose for which it is needed can be as effectively achieved in a way that is less
restrictive of the person’s rights and freedom of action.
Making an unwise or illogical decision are not by themselves indications of a lack
of capacity. Therefore, the only two factors that could suggest a lack of capacity
are the presence of an impairment or disturbance of mind or brain.
Assessing capacity
If it is suspected that a person has an impairment of mind or brain, then a carer must test
for capacity. All four tests should be done and results recorded
1. Can they understand the information?
NB. this must be imparted in a way the patient can understand
2. Can they retain the information?
NB. This only needs to be long enough to use and weigh the information
3. Can they use or weigh up that information?
NB. They must be able to show that they are able to consider the benefits and
burdens to the proposed treatment and the alternatives
4. Can they communicate their decision?
NB. The carers must try every method possible to enable this
Please Note: cognitive function tests (e.g. knowing date and place, or counting
backwards) do not test capacity. Being able to have a conversation or speaking clearly
tells you nothing about a person’s capacity, especially as the MCA is clear that the
responsibility is on the carer to enable the patient to communicate their wishes.
Further information
http://www.dca.gov.uk/legal-policy/mental-capacity/mca-cp.pdf
Published April 2010