The 5 MCA Key Principles Explained

The Mental Capacity Act (2005) is underpinned by five key principles that guide decision-making and assessments regarding mental capacity. Understanding these is vitally important to anyone working with the mental Capacity Act. Here’s an overview of each principle:

1. Presumption of Capacity

The first principle emphasizes that everyone should be assumed to have the capacity to make their own decisions unless proven otherwise. This may seem strange at first sight, but imagine if you went to see a Doctor but before you had even spoken they told you lacked the ability to make your own decisions. I suspect you would be very angry, as would I! So if this is true for you (and me) then it should be true for everyone.

This means that no one should automatically be considered unable to make a decision, just because they have a certain diagnosis, illness or disability. Capacity cannot therefore, be judged by appearances or assumptions.

It also means that the onus lies on the person who doubts an individual’s capacity to prove otherwise. This principle upholds respect and equality, challenging any biases that might otherwise undermine an individual’s autonomy.

2. Individuals Must Be Supported to Make Their Own Decisions

The second principle focuses on supporting individuals to make their own decisions whenever possible. This includes offering clear, accessible information and providing help in ways that are tailored to the individual’s needs, such as using simple language, visual aids, or allowing additional time for decision-making.

Sometimes people ask me if it is ‘cheating’ to give people information in an assessment. Imagine you are going to see the above Doctor again, this time about an operation. Before you made your decision you would expect to be given information about what to expect, the risks, the recovery period etc. Is having this information ‘cheating’? Of course not, and so once again if this applies to you, so it should apply to everyone.

This principle acknowledges that some people may face barriers to understanding information, but with the right support, they may be fully capable of making decisions. All reasonable supportive interventions should be tried before concluding that someone lacks capacity, emphasizing the importance of empowerment and promoting autonomy.

3. Right to Make Unwise Decisions

We all make unwise decisions at times and this principle ensures we have the freedom to make decisions that might seem unwise or risky to others.

People are entitled to make choices based on their own values, preferences, and perceptions of risk. This principle safeguards individuals from unnecessary intervention and respects their right to live as they wish, even if others disagree.

It’s important to distinguish between making an unwise decision and lacking the mental capacity to make a decision. There are two clear elements involved with making an informed, yet unwise decision. An ability to understand, retain, weigh and apply the risks and consequences of making or not making a decision and a sequential series of steps to their logic/thinking that takes the person from the evidence to the outcome.

4. Best Interests

This principle states that if a person is found to lack capacity, any decision made on their behalf must be in their best interests.

This principle is about ensuring that all actions taken for the individual reflect what is most beneficial to them. It requires the decision-maker to think about what the ‘best course of action’ is for the person on whose behalf they are making the decision. It should not be the personal views of the decision-maker rather it should consider both the current and future interests of the person who lacks capacity and weigh up these considerations and decide which course of action is on balance, the best for the individual lacking capacity. Factors such as past statements, family perspectives, and cultural considerations should also be taken into account. The “best interests” standard requires a holistic approach, prioritizing the person’s overall well-being and minimizing restrictions on their rights and freedoms.

5. The Less Restrictive Option

Finally, when someone lacks capacity and a decision must be made on their behalf, the less restrictive option should always be pursued. This principle ensures that any intervention has the minimal possible impact on the individual’s rights and freedoms and that they retains as much independence as they can manage. The goal is to allow the person to live with the highest level of independence and dignity.

Conclusion

The five principles of the Mental Capacity Act work together to create a balanced, respectful approach to decision-making. They emphasize autonomy, empowerment, and respect, promoting a culture that safeguards rights while recognizing the need for compassionate support when it is truly necessary. By adhering to these principles, caregivers, medical professionals, and family members can ensure that every individual is treated with fairness, understanding, and dignity.

If you are in need of a capacity assessment then please do get in touch via tim@timfarmer.co.uk