Mental Capacity Case Study

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Further, autonomous decisions would require adult patients to possess capacity as well as being voluntary and informed under the Mental Capacity Act (MCA). The capacity of adult patients to make decisions should initially be presumed unless proven otherwise. For adult patients without capacity, applying the patient’s ‘endorsed values would be an exercise in fiction’ as the patient might never had the capacity to formulate values and beliefs. An adult patient who lacks capacity is one who is unable to ‘(a) understand the information relevant to the decision, (b) to retain that information, (c) use or weigh that information as part of the process of making the decision, or (d) communicate his decision’.

In Re B, a competent patient has the …show more content…
Lord Woolf relied on Lord Scarman’s dissenting judgment in Bolam and stated that ‘if there is a significant risk that would affect the judgment of a reasonable patient’ then it is the responsibility of a doctor to inform the patient. A new duty was also introduced to consider the understanding and emotional condition of the patient. Similar to Lord Scarman in Sidaway, Lord Woolf recognised a patient’s right to self-determination instead of ‘patient autonomy’. The fact that judges shy away from the word ‘patient autonomy’, which is a more powerful connotation, shows that courts are not prepared to give greater recognition to patient autonomy.

It was not until Chester v Afshar which propelled patient autonomy to centre stage. Lord Steyn said that “in modern law medical paternalism no longer rules and a patient has a prima facie right to be informed by a surgeon of a small, but well established, risk of serious injury as a result of surgery.” This indicates the greater protection of patient’s autonomy through informed consent. Although the decision in Chester did not concern the standard of disclosure, it had a significant importance regarding the patient’s legal right to be …show more content…
Lord Kerr and Lord Reed recognised that ‘patients are now widely regarded as persons holding rights, rather than as passive recipients of the care of the medical profession’. This case establishes the law’s commitment to protecting patient’s autonomy and shows the appropriate recognition given to patients as decision makers. Montgomery defined the test of materiality as ‘a reasonable person in the patient’s position would be likely to attach significance to the risk, or the doctor is or should reasonably be aware that the particular patient would be likely to attach significance to it’. Furthermore, 'an adult person of sound mind is entitled to decide which, if any, of the available forms of treatment to undergo, and her consent must be obtained before treatment interfering with her bodily integrity is undertaken.’ Thus, there is a clear duty that doctors have to ensure that patients are aware of all the risks before giving consent to a particular treatment. Montgomery has indeed closed the gap between the law and the medical profession and calls for conversations between patients and doctors, shifting towards the partnership model. Moreover, it was said that ‘it is legal paternalism masquerading as patient autonomy’ thus this shows that
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