Does Lacking Capacity for One Decision Mean Lacking Capacity for All?

Many of us will recognise this scenario: a person struggles to understand a

complex decision such as managing a specific health problem, and then

suddenly they are treated as lacking capacity for every decision they make.

It’s a common misconception, but firmly at odds with the Mental Capacity Act

2005 (MCA).

No such thing as ‘blanket capacity’

The MCA’s first principle, the presumption of capacity, helps reminds us that

capacity is not a blanket label. Add to this that the courts have repeatedly

emphasised that each decision carries its own threshold of understanding and

we begin to understand that we cannot have a ‘one-assessment-fits-all’

mentality.

I cannot emphasis how important the threshold of understanding is to this. It

is basically what a person needs to know, in order to make a specific decision

(see my previous blog here).

As you would expect, the amount and complexity of information someone must understand varies depending on the decision itself. Simpler decisions require a lower threshold; complex, high-risk, or technical decisions demand a higher one.

This principle runs through-out case law, for example, Masterman-Lister v Brutton, PC v City of York Council, and later A Local Authority v JB.

This threshold explains why people may have capacity for some decisions but

not others. A person might lack capacity to litigate because they cannot grasp

or weigh the process and financial implications (a relatively high threshold)

yet still have capacity to make a Lasting Power of Attorney (a lower, more

values-based threshold).

Similarly, someone may be unable to understand the risks of refusing life-saving treatment but have no difficulty choosing their meals, daily activities, or relationships. The decision itself defines the extent that a person needs to understand, retain, weigh up and use and communicate.

To avoid going down the ‘blanket capacity’ route, an assessors should:

1. Define the decision precisely, which includes identifying the correct threshold of understanding.

2. Present only the salient information, avoiding overload that artificially raises the threshold.

3. Provide appropriate support, such as adjusted language, visual aids, or time to process information.

4. Identify whether the decision is Micro or Macro (see more in my blog

here)

5. Reassess when indicated, particularly when there is a change in presentation or when the threshold for a new decision is different.

Mental Capacity is very much decision specific and there is no such thing as

‘blabnket capacity’. Recognising that capacity depends on the decision specific

threshold of understanding is key to understanding this and ensuring best

practice.

By embedding this into your practice and applying the MCA correctly,

you can ensure that those you assess retain control over their own lives

wherever possible, while still receiving and support when genuinely needed.