Understanding the Mental Capacity Act (MCA) and Its Core Principles
The Mental Capacity Act (MCA) is a piece of legislation designed to protect and empower individuals who may lack the mental capacity to make their own decisions. It applies to decisions about an individual's personal welfare, finances, and healthcare, and is based on five key principles. These principles serve as the foundation for any assessment or action taken under the Act.
The Five Core Principles of the MCA
- Presumption of Capacity: A person must be assumed to have capacity unless it is established otherwise. The burden of proof lies with the person asserting a lack of capacity.
- Right to Be Supported: A person is not to be treated as unable to make a decision unless all practicable steps to help them do so have been taken without success. This includes providing information in an accessible format.
- Right to Make Unwise Decisions: An unwise decision, or one that others might disapprove of, does not necessarily mean a person lacks capacity. This principle protects a person's autonomy.
- Best Interests: Any decision made on behalf of a person lacking capacity must be made in their best interests. This is a complex process involving multiple considerations.
- Least Restrictive Option: Any act or decision made for a person who lacks capacity must be the least restrictive of their rights and freedom of action. This means exploring all options to ensure maximum independence is maintained.
The Two-Stage Test for Assessing Capacity
When determining what is the MCA for someone with dementia and if it applies, the assessor must follow a two-stage test:
- Diagnostic Test: Is there an impairment of, or a disturbance in, the functioning of the mind or brain? In the case of dementia, this condition satisfies the first stage of the test.
- Functional Test: Does the impairment or disturbance make the person unable to make a specific decision when it needs to be made? This part is crucial, as capacity is always decision-specific and not a blanket diagnosis. To prove a lack of capacity, the person must be unable to do one or more of the following:
- Understand the information relevant to the decision.
- Retain that information long enough to make the decision.
- Use or weigh that information as part of the decision-making process.
- Communicate their decision by any means.
Dementia and the Impact on Mental Capacity
It is a common misconception that a dementia diagnosis automatically means a person lacks mental capacity. This is incorrect. The MCA's two-stage test clarifies that the assessment is specific to the decision being made at a particular time.
Fluctuating Capacity
One of the complexities of dementia is that a person's capacity can fluctuate. They may have the capacity to make a decision on one day but not the next. The MCA recognizes this, and assessments must be made at the time the decision is required, not based on a general assumption.
Decision-Specific Assessments
This decision-specific approach is central to the MCA. A person with early-stage dementia might still have the capacity to make complex financial decisions but struggle with decisions regarding their personal care. As the condition progresses, their capacity to make certain decisions will likely decrease.
The Role of Lasting Power of Attorney (LPA)
An LPA is a powerful legal tool that allows a person (the donor) to appoint one or more people (attorneys) to make decisions on their behalf. There are two types of LPA:
- Health and Welfare LPA: Covers decisions about healthcare, medical treatment, and where they live.
- Property and Financial Affairs LPA: Covers decisions about money, property, and finances.
An LPA is set up while the person still has the capacity to do so. Once registered, it comes into effect when the person loses the capacity to make their own decisions.
Comparison: When to Use an MCA vs. an LPA
| Feature | Mental Capacity Act (MCA) | Lasting Power of Attorney (LPA) |
|---|---|---|
| Purpose | To provide a legal framework for assessing capacity for a specific, current decision. | To appoint a trusted person to make future decisions on your behalf if you lose capacity. |
| When it's used | When a person's capacity to make a specific decision is in doubt, and no LPA is in place for that area. | When a person has lost capacity, and a registered LPA is in effect. |
| Initiated by | Anyone concerned about the person's welfare, often by family, doctors, or social workers. | The person themselves, while they still have capacity, by creating and registering the LPA. |
| Decision-maker | The professional assessing capacity and making a best interests decision (or an appointed LPA attorney if one exists). | The appointed attorney(s) follow the LPA instructions, considering the person's best interests. |
Safeguarding Best Interests
For someone with dementia who lacks capacity to make a specific decision, any decision made on their behalf must be in their best interests. The MCA provides guidance on how to determine this, including:
- Considering the person's past and present wishes and feelings.
- Consulting with family members, friends, and caregivers who know the person well.
- Involving the person as much as possible in the decision-making process.
- Avoiding making assumptions based on their condition.
For more detailed guidance on legal issues for individuals with dementia, the Alzheimer's Society provides comprehensive resources on the Mental Capacity Act and related topics.
Conclusion: Navigating Care with Understanding
The MCA is a vital tool for ensuring that individuals with dementia are treated with dignity and have their autonomy respected for as long as possible. Understanding what is the MCA for someone with dementia is crucial for family members, caregivers, and healthcare professionals alike. It is a framework that prioritizes the individual's wishes and best interests, moving away from blanket assumptions about capacity based solely on a diagnosis. By following its principles, we can provide better, more person-centered care and support for those living with dementia.
