The Mental Capacity Act (MCA) 2005 is built upon five core principles designed to protect individuals who may lack capacity to make their own decisions and to empower them to make as many decisions as they can for themselves. These principles guide anyone making decisions or taking action on behalf of someone who lacks capacity.
The Five Core Principles of the Mental Capacity Act
Understanding these principles is fundamental to applying the Act correctly in practice. They form a hierarchical framework, meaning you consider them in order, starting with the presumption of capacity.
Principle 1: A Presumption of Capacity
Every adult has the right to make their own decisions and must be assumed to have capacity to do so, unless it is proven otherwise.
- What this means: You cannot assume someone lacks capacity simply because they have a particular medical condition, disability, or look frail. Capacity must be assessed specifically for the decision that needs to be made at the time it needs to be made.
- Practical Insight: Don't label someone as lacking capacity just because past decisions or current circumstances might suggest they struggle. Always start by assuming they can decide.
Principle 2: Individuals Being Supported to Make Their Own Decisions
A person is not to be treated as unable to make a decision unless all practicable steps to help them to do so have been taken without success.
- What this means: Before concluding someone lacks capacity, you must explore and implement all reasonable ways to support them in making the decision. This could involve using different communication methods, providing information in accessible formats, or choosing the right time and place for discussion.
- Examples of Support:
- Using visual aids or simple language.
- Breaking down complex information into smaller parts.
- Allowing more time for the person to process information.
- Involving people who know the person well (e.g., family members, support workers) to help with communication or understanding their usual preferences.
- Key Takeaway: Lack of capacity is a last resort, not a first assumption.
Principle 3: Unwise Decisions
An unwise decision made by a person with capacity does not mean they lack capacity.
- What this means: People have the right to make decisions that others might see as eccentric, unconventional, or simply poor choices, as long as they have the capacity to understand the decision and its potential consequences.
- Practical Insight: This principle protects autonomy. You cannot override a person's decision simply because you disagree with it or think there's a better option, provided they have capacity. The focus is on the ability to decide, not the quality of the decision.
Principle 4: Best Interests
An act done, or decision made, under the Act for or on behalf of a person who lacks capacity must be done, or made, in their best interests.
- What this means: When a person is assessed as lacking capacity for a specific decision, any action taken or decision made for them must be in their best interests. This requires considering all relevant circumstances, including their past and present wishes, feelings, beliefs, and values.
- Best Interests Checklist (MCA Section 4): The Act provides a checklist to guide best interests decisions, emphasizing factors like:
- Encouraging the person's participation.
- Considering their past wishes and feelings.
- Consulting with relevant others (family, carers, etc.).
- Avoiding discrimination.
- Considering whether the person might regain capacity.
- Crucial Point: Best interests are not solely about what is medically best but encompass the person's overall well-being and quality of life from their perspective as much as possible.
Principle 5: Less Restrictive Option
Before taking any action or making a decision on behalf of a person who lacks capacity, consider whether there is a less restrictive option available that will still meet their needs.
- What this means: Any intervention or decision made for someone lacking capacity should be the least restrictive of their rights and freedoms while still achieving the desired outcome. This promotes dignity and respects their remaining abilities.
- Examples:
- Can support be offered instead of a blanket restriction?
- Is there a way to manage a risk that impacts capacity without removing all choice?
- Instead of moving someone from their home, could they receive care and support there?
- Principle in Action: This principle encourages tailored solutions that maximise the person's independence and autonomy, even when they lack capacity in some areas.
These five principles are the bedrock of the Mental Capacity Act, ensuring that the rights and autonomy of individuals are upheld, whether they have capacity or not. They promote a framework of support, respect, and tailored decision-making.
Summary Table of MCA Principles
| Principle | Core Concept | Key Action/Focus |
|---|---|---|
| 1. Presumption of Capacity | Assume capacity unless proven otherwise. | Do not label based on condition; assess capacity for the specific decision. |
| 2. Support to Make Decisions | Take all practicable steps to help the person decide. | Explore different communication methods, accessible information, timing, and environment. |
| 3. Unwise Decisions | People with capacity can make decisions you disagree with. | Respect autonomous decisions, even if seen as unwise, as long as the person has capacity. |
| 4. Best Interests | Act/decide for a person lacking capacity in their best interests. | Consider past/present wishes, feelings, beliefs, values; use the Best Interests Checklist; consult others. |
| 5. Less Restrictive Option | Choose the least restrictive option when acting/deciding. | Explore alternatives that maximise the person's freedom and rights while still meeting their needs. |
