QuestionSBA
QuestionChoice
The patient has capacity and can communicate his decision. There's no indication of psychiatric illness here so a referral to psychiatry is not indicated or appropriate
32395
c
Refer to psychiatry for a full psychiatric assessment
QuestionChoice
As long as the patient has retained, understood, weighed up and communicated a decision, there is no need for further justification unless you are unsure of the patient's understanding
32397
e
Ask the patient to justify his decision
QuestionChoice
The three key components for informed consent are capacity, provision of adequate information and non-coercion. The patient has the capacity to decide about his feeding as he can understand, retain, weigh up, and communicate a decision. Therefore, his wishes should be accepted
32393
a
Accept the patient's decision and continue with risk-feeding
QuestionChoice
The patient has the capacity to make this decision as he can understand, retain, weigh up, and communicate his wishes
32394
b
Start a pureed diet as the patient lacks capacity
QuestionChoice
As the patient has met the criteria for having the capacity to make a decision regarding his feeding, there is no need to reassess
32396
d
Reassess capacity the following day
Concept
Chapter
# Criteria used when assessing capacity in adults

There are **four criteria** used when assessing capacity in adults.

1. The individual must be able to understand the information relating to the decision
2. The individual must be able to retain that information
3. The individual must be able to weigh up the information and reach a conclusion
4. The individual must be able to communicate the decision they have made.

# Ways to Meet the Criteria 

Help and support can be provided in order to enable an individual to meet the above assessment criteria. For example, using simple language in order to explain the information, or allowing someone to communicate their decision in a number of ways (in writing, verbally, in sign-language, or their normal form of communication, etc.)

# Mental Capacity Act 

If an individual is not able to do any of the above four criteria, then the Mental Capacity Act (MCA) will assess them and therefore treat them as lacking capacity for that specific decision in question.

# Fluctuating Capacity 

It is important to note here that capacity is not absolute. Sometimes, an individual's capacity can fluctuate (e.g. someone with dementia). Or in other circumstances, someone will have the capacity to make a decision on something simple but not something more complex. It is therefore always important to assess whether individuals have the capacity to make a _specific_ decision at that time.
573
588
Criteria for assessing capacity in adults
Topic
30
Ethics and Law
6479
Patients with capacity have the right to refuse medical recommendations, even if it poses risks to their health.
A 56-year-old man with progressive motor neurone disease is assessed by the speech and language team due to concerns about his swallowing.

Following the assessment, the recommendation is that he would benefit from a pureed diet to reduce the risk of aspiration.

Having explained the recommendation and the risks associated with continuing with a normal diet, the patient refuses and states that he wishes to continue with a normal diet. He can understand, retain and weigh up the decision but only able to communicate in writing.

Which of the following is the next best step in management?
a