Assessing capacity is ‘decision specific’; someone might have the capacity to make some decisions but lack the capacity to make others.
In relation to the relevant decision, can the person:
- UNDERSTAND the decision
- RETAIN the information, for long enough to:
- WEIGH UP the issues/risk
- COMMUNICATE their decision
If the answer is YES to all four, the person has capacity.
Some principles of the Act include:
- An assessment must always start from an assumption that the person has capacity.
- People have the right to make what others may consider to be eccentric or unwise decisions.
- All efforts should be made to give someone the best chance to show they have capacity and to support them to make a decision for themselves if they can.
- Before making a ‘Best Interest’ decision on another person’s behalf, there must be evidenced, reasonable belief that the person cannot make that particular decision for themselves.
- Fluctuating capacity must also be considered; is the person is likely to regain capacity and if so, can the decision be delayed?
- If, for example the person is unconscious, a paramedic may decide medical treatment cannot be delayed.
- if a decision is less urgent, it could possibly be delayed until the person regains their capacity, or until all practical steps have been taken to confirm whether they have capacity. This might mean, for example,
- considering what time of day the person is at their best
- treating an acute infection that might be having an impact
- involving another person who knows them well, or a relevant specialist, for example a speech and language therapist to assist the person to communicate, if speech is a difficulty.