Skip to main content Accessibility help
  • Print publication year: 2019
  • Online publication date: June 2019

Chapter 7 - Clinical Ambiguities in the Assessment of Capacity


Medical practitioners have long voiced their frustrations about the development of legal tests that are difficult to apply to clinical situations, as exemplified by this quote from Roth et al. (1977).

Adults with Incapacity (Scotland) Act) (2000) London: HMSO.
Appleby, L. (2009) Letter to Royal College of Psychiatrists: Mental Health Act 1983 and the treatment of the physical consequences of self-harm.…/applebyletter.aspx.
Bellhouse, J., Holland, A., Clare, I. C., et al. (2003) Capacity-based mental health legislation and its impact on clinical practice: 2) treatment in hospital. Journal of Mental Health Law, 24–37.
Carpenter, W. T. Jr, Gold, J. M., Lahti, A. C., et al. (2000) Decisional capacity for informed consent in schizophrenia research. Archives of General Psychiatry, 57(6), 533538.
David, A., Hotopf, M., Moran, P., et al. (2010) Mentally disordered or lacking capacity? Lessons for management of serious deliberate self-harm. British Medical Journal, 7, 341, c4489.
Grisso, T. & Appelbaum, P. S. (1991) Mentally ill and non-mentally-ill patients’ abilities to understand informed consent disclosures for medication: Preliminary data. Law and Human Behaviour, 15(4), 377388.
Grisso, T. & Appelbaum, P. S. (1995) The MacArthur Treatment Competence Study. III: Abilities of patients to consent to psychiatric and medical treatments. Law and Human Behaviour, 19(2), 149174.
Grisso, T., Appelbaum, P. S. & Hill-Fotouhi, C. (1997) The MacCAT-T: A clinical tool to assess patients’ capacities to make treatment decisions. Psychiatric Services, 48(11), 14151419.
Gunn, M. (1994) The meaning of incapacity. Medical Law Review, 2, 829.
Hassan, T. B., MacNamara, A. F., Davy, A., et al. (1999) Lesson of the week: Managing patients with deliberate self-harm who refuse treatment in the accident and emergency department. British Medical Journal, 319(7202), 107109.
Hawton, K., Fagg, J. & McKeown, S. P. (1989) Alcoholism, alcohol and attempted suicide. Alcohol and Alcoholism, 24(1), 39.
Herring, J. (2008) Entering the fog: On the borderlines of mental capacity. Indiana Law Journal, 83(4). Article 16.
In the estate of Park (1953) 2 All E.R.40.
Jacob, R., Clare, I. C., Holland, A., et al. (2005) Self-harm, capacity, and refusal of treatment: Implications for emergency medical practice – a prospective observational study. Emergency Medical Journal, 22(11), 799802.
Kennedy, I. (1992) Consent to treatment: The capable person. In: Doctors, Patients, and the Law (ed. Dyer, C.), pp. 44–71. Oxford: Blackwell Scientific Publications.
Keywood, K. (1995) B v. Croydon Health Authority 1994, CA: Force-feeding the Hunger Striker under the Mental Health Act 1983. Current Legal Issues.
Larkin, G. L., Marco, C. A. & Abbott, J. T. (2001) Emergency determination of decision-making capacity: Balancing autonomy and beneficence in the emergency department. Academic Emergency Medicine, 8(3), 282284.
Mackay, N. & Barrowclough, C. (2005) Accident and emergency staff’s perceptions of deliberate self-harm: Attributions, emotions and willingness to help. British Journal of Clinical Psychology, 44(2), 255267.
Marson, D. C., Chatterjee, A., Ingram, K., et al. (1996) Toward a neurological model of competency: Cognitive predictors of capacity to consent in Alzheimer’s disease using three different legal standards. Neurology, 46(3), 666672.
Mason, J. K. & Laurie, G. T. (2006) Mason and McCall Smith’s Law and Medical Ethics. 7th edn. Oxford University Press. (When referring to this book, I am specifically referring to chapters 1, 10 and 20, which are titled Medical Ethics and Medical Practice, Consent to Treatment, and Mental Health and Human Rights, respectively.)
McLean, S. (2009) Living wills and refusing treatment: The Kerrie Wooltorton case. Wooltorton…/sheila-mclean-on-advance-directives-and-the-case-of-K-Wooltorton.
Mental Capacity Act (2005) London: HMSO.
Mental Capacity Act, Code of Practice (2007).
Mental Health Act (1983) London: HMSO.
NICE Guidelines. Self-harm (2004) The short-term physical and psychological management and secondary prevention of self-harm in primary and secondary care. CG16.
Owen, G. S., David, A. S., Richardson, G., et al. (2009) Mental capacity, diagnosis and insight. Psychological Medicine, 39, 13891398.
Raymont, V., Bingley, W., Buchananan, A., et al. (2004) Prevalence of mental incapacity in medical inpatients and associated risk factors: Cross-sectional study. Lancet, 16–22(364), 14211427.
Roth, L. H., Meisel, A. & Lidz, C. W. (1977) Tests of competency to consent to treatment. American Journal of Psychiatry, 134 (3), 279284.
Szmukler, G. (2004) Mental health legislation is discriminating and stigmatising In: Every Family in the Land (ed. Crisp, A.), The Royal Society of Medicine Press.
Wong, J. G., Clare, I. C. H., Gunn, M. J., et al. (1999) Capacity to make health care decisions: Its importance in clinical practice. Psychological Medicine, 29(2), 437446.
Wong, J. G., Clare, I. C. H., Holland, A. J., et al. (2000) The capacity of people with a ‘mental disability’ to make a health care decision. Psychological Medicine, 30 (2), 295306.
A Local Authority v. E (by her Litigation Friend the Official Solicitor) [2012].
B v. Croydon Health Authority [1995] 1 All ER 683.
Re B (Adult: Refusal of Medical Treatment) [2002] EWHC 429 (Fam).
Re C (Adult: Refusal of Medical Treatment)[1994] 1 All ER 819.
Re F (Mental Patient: Sterilisation) [1990] 2 AC 1.
Re R [1991] 4 ALL ER 177 CA.
Re SB (A Patient: Capacity To Consent To Termination) [2013] EWCOP 1417.
St George Healthcare NHS Trust v. S [1993] 3 All ER 673.