Skip to content
Home » Consent


Man in electric wheelchair looking out to the sea

Case study: What do we mean by ‘decision specific’?

We all make many thousands of micro-decisions on a daily basis, from the way we make a cup of tea to what we watch on TV. However, when it comes to decision making, the Mental Capacity Act (2005) is ‘decision specific’. This means that it relates to a specific decision made at a specific time. It does not refer to decision-making more broadly. This raises the question: how specific do we need to be when we assess capacity?

Woman in wheelchair signing consent form

Mental Capacity and informed consent

Consent refers to a person’s voluntary assent to a particular action, decision or interaction. There are many different types of consent. These include:

  • Implied consent – where no verbal or written consent has been given, but an action by the individual in question suggests their agreement. For example, if a patient offers their arm to have their blood pressure taken.  
  • Informed consent – requires an explicit understanding of all the relevant facts, including risks and available alternatives. Usually, information is provided in order to help the person to understand what is proposed and why. This type of consent is often associated with medical procedures in healthcare settings; it is also often formalised with a physical signature on a consent form.
Young man taking photo, pointing camera towards the viewer.

Mental capacity in practice: Consent to be photographed

In everyday healthcare practice we are directed by legislation and best practice guidance to gain informed consent for medical interventions, care plans and, broadly speaking, any professional interaction. This includes consent to be photographed, which in years gone by would have included use on medication charts (MARS sheets), care plans and care provider notice boards. In more recent years, it also includes the use of photos shared on social media, email and messaging services such as WhatsApp.

Dealing with trauma: young man staring into distance

Clients who are unwilling or unable to engage

There are many occasions where an individual may be unwilling or unable to engage with a mental capacity assessment. It is not a rare event by any means, and there are many possible reasons why this may occur. For example, there may be an issue with the specific context of the situation, the individual’s health conditions, the professional’s approach to the test, or even the adaptations that have been made to support.

Consent to treatment: patient preparing for an MRI scan

Using LEGO to support capacity and enable informed consent

LEGO has launched a new kit designed to help ease children’s anxieties around using an MRI scanner. This fantastic toy helps bridge the gap in understanding around what is going to happen, putting the process of an MRI scan in terms that a child can understand, facilitating their comprehension and thereby reducing anxiety around the whole process.

Gillick competence. Teenager receiving injection from doctor.

Gillick Competence and the Fraser Guidelines

The Mental Capacity Act (2005) currently applies to adults aged 16 years and above. However, as with many things, there are specific areas of exception. One of which is known as ‘Gillick Competency’ (or Gillick Competence), and the related Fraser Guidelines. These two important judgements set out rules around when a young person is deemed competent to make their own decisions without specific parental consent.

Elderly gentleman and young man in red hat smiling and enjoying time together. Photo by Nathan Anderson on Unsplash.

Mental Capacity and consent

When I first started working in healthcare there was very little said about capacity yet there was a lot of emphasis said about consent, especially that of informed consent. Consent to treatment, consent to an intervention, consent to support with personal care, consent to speak to a family member, consent to take photos, consent to store information or share with the GP. The list is quite endless and is a staple of not just the health care system, but our society as a whole that has grown in importance over the years.