
The following illustration may help:
In my work with adults with learning disabilities I have sometimes had to undertake assessments to determine whether individuals have the capacity to make certain decisions. Where they are assessed as not having the capacity, I am required to determine what is in their best interests. In doing so, I have to exercise care to ensure that I do not infringe a person's human rights and that I apply the Mental Capacity Act (MCA) criteria of decision-specific and time-specific considerations of capacity. In assessing T, a 36 year man with severe autism who had become physically unwell, I was asked to determine whether he should be taken to hospital for treatment. He was showing signs of reluctance to go, but his health was deteriorating and I recognised that he needed medical help. I explored first how much medical assistance could be given at his residential home and I liaised with his GP to do just that. I knew from previous work with T that he would become very distressed if his usual routine was disrupted. I considered all of the criteria mentioned in s4 of the Mental Capacity Act 2005 and I undertook a capacity assessment to determine whether T had the capacity to make a decision about his immediate health care and treatment at that moment. In addition, as T had no other family or friends to support him, I specifically consulted T's Independent Mental Capacity Advocate. This ensured that I supported T to participate in the decision as much as he was able and ensure that I fully considered T's wishes and feelings. I knew that he would be reluctant to have his routine disrupted but I also could see that he was suffering with poor health. Eventually, I did decide that it was in his best interests to be taken to hospital so that medical treatment could be given as per section 5 of the MCA. I recorded this as accurately as I could. I then prepared the hospital for T's admission so that they knew how to cope with his needs and so that he could be discharged as quickly as possible.