Assessing capacity

Act now

1. 1

   Emergency treatment to prevent serious harm can go ahead if they lack capacity — document why.

Assess

• Is there an impairment of mind or brain (in Scotland, a mental disorder or inability to communicate)?
• Can they understand the information, retain it, use or weigh it, and communicate a decision?
• Give them every chance: right time, glasses and hearing aids, interpreter, simple language. Treat delirium first if the decision can wait.

Investigations

• 4AT and a delirium screen for reversible causes.

Manage

• Check for a welfare attorney or guardian (Scotland), a health and welfare LPA or deputy (England and Wales), and any valid advance decision.
• England and Wales: best-interests checklist, consult family and carers, IMCA if there is no one, least restrictive option.
• Scotland: AWI principles — benefit, least restrictive, the person's past and present wishes, consult relevant others, encourage residual capacity.
• Document the decision, the assessment and the reasoning.

Escalate when