Risk, Capacity & Safeguarding — MCQs
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A 38-year-old woman with recurrent depression is seen in the community mental health clinic. She describes passive suicidal thoughts but states she would never act on them because of her two young children. She has good engagement with services and attends all appointments. Her mood has been gradually improving on antidepressant therapy. What is the most appropriate management of her suicide risk at this stage?
A 63-year-old man with alcohol-related brain damage (Wernicke-Korsakoff syndrome) is being assessed for capacity to make decisions about his accommodation. During assessment, he confabulates extensively, providing detailed but false accounts of recent events. He insists he lives independently, though he has been in hospital for 3 months. Which cognitive deficit most directly impairs his capacity in this situation?
A 27-year-old man with no psychiatric history presents to his GP describing intrusive thoughts about jumping in front of trains. He is distressed by these thoughts and emphasizes he does not want to die. He has recently started a new relationship and has been promoted at work. He has no history of depression or anxiety. What is the most appropriate initial interpretation of these symptoms?
A 56-year-old woman with schizophrenia requires electroconvulsive therapy (ECT) for severe catatonic depression. She is mute and immobile. She has previously received ECT with good effect. A capacity assessment concludes she lacks capacity to consent to ECT. She has a Lasting Power of Attorney (LPA) for Health and Welfare. Her attorney agrees ECT should proceed. What additional step is legally required before ECT can be administered?
During a suicide risk assessment, a 46-year-old man with depression describes detailed thoughts about hanging himself. He has researched methods online and identified a location. However, he has not purchased any materials. He lives alone but has regular contact with his adult son. Which classification best describes his current level of suicidal ideation?
A 79-year-old man with moderate Alzheimer's dementia (MMSE 13/30) requires urgent surgery for a perforated bowel. He repeatedly refuses consent, stating 'I want to go home now'. His wife reports that 6 months ago, before his dementia worsened, he told her he would 'never want surgery' if he became confused. He has not made a Lasting Power of Attorney or Advance Decision to Refuse Treatment. What is the correct legal basis for proceeding with the surgery?
A 41-year-old woman with a history of emotionally unstable personality disorder presents to the Emergency Department following superficial cuts to her forearms. She states she did this to 'feel something' after an argument with her partner. She denies any wish to die and says she feels better now. Her physical injuries are minor and do not require admission. What is the most appropriate approach to managing her suicide risk in this situation?
According to the Mental Capacity Act 2005, which one of the following statements correctly describes the principle regarding the timing of capacity assessment?
A 34-year-old man with recurrent depression is reviewed in the psychiatric outpatient clinic. He describes ongoing suicidal thoughts but denies any specific plans. When asked about protective factors, he mentions his elderly mother who depends on him for care. During the consultation, he becomes tearful when discussing his mother's deteriorating health. Which aspect of this presentation most significantly increases his suicide risk?
A 68-year-old woman with a 2-year history of Alzheimer's dementia (MMSE 19/30) refuses to take her newly prescribed anticoagulation for atrial fibrillation. When asked why, she states she 'doesn't like taking tablets' but cannot explain the risks of not taking the medication or the benefits of taking it. She can repeat back what you have told her about the medication. What is the most appropriate next step in assessing her capacity to refuse this treatment?
Risk, Capacity & Safeguarding UK Medical PG Practice Questions and MCQs
Question 61: A 38-year-old woman with recurrent depression is seen in the community mental health clinic. She describes passive suicidal thoughts but states she would never act on them because of her two young children. She has good engagement with services and attends all appointments. Her mood has been gradually improving on antidepressant therapy. What is the most appropriate management of her suicide risk at this stage?
- A. Arrange immediate psychiatric admission for safety
- B. Continue community management with regular monitoring (Correct Answer)
- C. Increase frequency of home visits by the crisis team
- D. Refer to the crisis team for daily monitoring
- E. Stop her current antidepressant due to increased suicide risk
Explanation: ***Continue community management with regular monitoring*** - The patient has **passive suicidal ideation** without active planning or intent, and strong **protective factors** (her children) are present, making community management appropriate. - Her **good engagement** with services and **gradually improving mood** on antidepressant therapy indicate stability and effective ongoing care. *Arrange immediate psychiatric admission for safety* - **Immediate psychiatric admission** is indicated for acute, high-risk situations with active suicidal intent or inability to ensure safety in the community. - This patient has **passive ideation** and strong **protective factors**, making admission an overly restrictive and potentially counterproductive intervention. *Increase frequency of home visits by the crisis team* - Increasing **crisis team involvement** or intensive home treatment is typically reserved for **acute exacerbations** or significantly heightened risk, which is not present here. - The patient's **stable engagement** and improving mood suggest that the current level of care is appropriate, without the need for intensive crisis intervention. *Refer to the crisis team for daily monitoring* - **Daily monitoring** by a crisis team is an intensive intervention suitable for individuals with **imminent risk** or severe functional impairment requiring constant oversight. - The patient's situation, characterized by **improving mood** and **passive suicidal thoughts**, does not warrant such a high level of intervention. *Stop her current antidepressant due to increased suicide risk* - There is no indication that the antidepressant is increasing suicide risk; in fact, her **mood is gradually improving** on the medication. - **Stopping an effective antidepressant** in a patient with recurrent depression would likely lead to a **relapse** and could paradoxically increase actual suicide risk.
Question 62: A 63-year-old man with alcohol-related brain damage (Wernicke-Korsakoff syndrome) is being assessed for capacity to make decisions about his accommodation. During assessment, he confabulates extensively, providing detailed but false accounts of recent events. He insists he lives independently, though he has been in hospital for 3 months. Which cognitive deficit most directly impairs his capacity in this situation?
- A. Inability to retain information for sufficient time
- B. Inability to understand relevant information
- C. Global cognitive impairment affecting all domains equally
- D. Inability to communicate his decision
- E. Inability to use and weigh information due to impaired insight (Correct Answer)
Explanation: ***Inability to use and weigh information due to impaired insight*** - In **Wernicke-Korsakoff syndrome**, the extensive **confabulation** and insistence on false realities (e.g., living independently despite hospitalization) signify a profound lack of **insight** into his actual situation. - This directly impairs his ability to **use and weigh information** about his accommodation options, as he cannot process the true facts of his 3-month hospitalization. *Inability to retain information for sufficient time* - While **anterograde amnesia** is a hallmark of Korsakoff syndrome, the primary issue described is not merely forgetting new information after it's presented. - His **confabulations** indicate a deeper distortion of reality and a failure to *integrate* existing true information, which is distinct from simple retention failure. *Inability to understand relevant information* - Patients with Korsakoff syndrome often retain the ability to **understand basic facts** and the meaning of words when they are explained. - The failure lies not in comprehension of the facts, but in accepting and incorporating this **truthful information** into his decision-making due to his distorted perception. *Global cognitive impairment affecting all domains equally* - **Korsakoff syndrome** is characterized by **disproportionate deficits** in memory (especially anterograde amnesia) and executive function, rather than a uniform decline across all cognitive domains as seen in some advanced dementias. - Many other cognitive functions, such as language expression, can be relatively preserved, though the content may be affected by confabulation. *Inability to communicate his decision* - The patient's **extensive confabulations** clearly demonstrate his ability to communicate verbally, even if the content is false and reflects impaired insight. - This option typically refers to physical barriers to communication (e.g., severe dysarthria or aphasia), which are not indicated as the core problem here.
Question 63: A 27-year-old man with no psychiatric history presents to his GP describing intrusive thoughts about jumping in front of trains. He is distressed by these thoughts and emphasizes he does not want to die. He has recently started a new relationship and has been promoted at work. He has no history of depression or anxiety. What is the most appropriate initial interpretation of these symptoms?
- A. Active suicidal ideation requiring urgent psychiatric referral
- B. Intrusive thoughts potentially consistent with obsessive-compulsive disorder (Correct Answer)
- C. Psychotic symptoms requiring antipsychotic medication
- D. Normal stress response to recent life changes
- E. Early warning sign of emerging bipolar disorder
Explanation: ***Intrusive thoughts potentially consistent with obsessive-compulsive disorder*** - The patient's thoughts are **ego-dystonic**, meaning they are inconsistent with his self-concept and cause significant **distress**, which is a hallmark of **Obsessive-Compulsive Disorder (OCD)**. - He explicitly states he **does not want to die**, differentiating these unwanted intrusive thoughts from genuine **suicidal intent** or hopelessness. *Active suicidal ideation requiring urgent psychiatric referral* - **Active suicidal ideation** involves a desire to end one's life or a specific plan, whereas this patient is distressed by the thoughts and wants them to stop. - He lacks the typical risk factors of **depression**, **hopelessness**, or a history of mental health issues, making a primary suicidal crisis less likely. *Psychotic symptoms requiring antipsychotic medication* - **Psychotic symptoms** like delusions or command hallucinations involve a loss of reality testing; this patient has full **insight** that these thoughts are irrational and unwanted. - There are no symptoms of **thought insertion** or external control, which are common in psychotic disorders but absent here. *Normal stress response to recent life changes* - While a promotion and new relationship are major life events, **harm-focused intrusive thoughts** are not a typical or "normal" reaction to positive stress. - A **normal stress response** typically involves transient worry or tension, not persistent, distressing thoughts that interfere with mental well-being. *Early warning sign of emerging bipolar disorder* - **Bipolar disorder** typically presents with identifiable episodes of **mania** (elevated mood, decreased need for sleep) or depression, neither of which are described. - Intrusive thoughts are a feature of the **anxiety spectrum** (specifically OCD) rather than a common prodromal feature of **mood cycling** or bipolarity.
Question 64: A 56-year-old woman with schizophrenia requires electroconvulsive therapy (ECT) for severe catatonic depression. She is mute and immobile. She has previously received ECT with good effect. A capacity assessment concludes she lacks capacity to consent to ECT. She has a Lasting Power of Attorney (LPA) for Health and Welfare. Her attorney agrees ECT should proceed. What additional step is legally required before ECT can be administered?
- A. Application to the Court of Protection for authorization
- B. Detention under Section 3 of the Mental Health Act
- C. No additional steps - the LPA decision is sufficient
- D. Obtaining a second opinion from a Section 12 approved doctor
- E. Obtaining approval from a Second Opinion Appointed Doctor (SOAD) (Correct Answer)
Explanation: ***Obtaining approval from a Second Opinion Appointed Doctor (SOAD)*** - Under **Section 58A** of the **Mental Health Act (MHA)**, **Electroconvulsive Therapy (ECT)** for a patient who lacks capacity requires approval from a **Second Opinion Appointed Doctor (SOAD)**, even if they are an informal patient. - The **SOAD**, appointed by the **Care Quality Commission (CQC)**, must certify that the treatment is clinically appropriate and that there is no valid **advance decision** refusing the treatment. *Application to the Court of Protection for authorization* - An application to the **Court of Protection** is typically reserved for complex disputes regarding **best interests** or significant long-term welfare decisions, not for the standard safeguarding procedure for **ECT**. - The legal framework for authorizing **ECT** for patients lacking capacity is specifically addressed by the **Mental Health Act**, making a Court of Protection application redundant in this scenario. *Detention under Section 3 of the Mental Health Act* - **Detention** under **Section 3 MHA** is not a prerequisite for receiving **ECT**; a patient can be informal but still require the **SOAD** safeguard if they lack capacity. - Even if the patient were detained under **Section 3**, **ECT** for a patient lacking capacity would still mandatorily require **SOAD approval** under **Section 58A MHA**. *No additional steps - the LPA decision is sufficient* - While a **Lasting Power of Attorney (LPA)** for Health and Welfare generally allows an attorney to make decisions on behalf of someone lacking capacity, **ECT** is a specific treatment with unique statutory safeguards. - **Section 58A MHA** specifically overrides the general powers of an **LPA** for **ECT** treatment, requiring independent **SOAD** authorization. *Obtaining a second opinion from a Section 12 approved doctor* - A **Section 12 approved doctor** is qualified to make recommendations for **MHA detention** but is not the designated authority for **ECT** safeguarding. - The specific requirement for **ECT** when a patient lacks capacity is review and approval by a **Second Opinion Appointed Doctor (SOAD)**, who has a distinct role and appointment process through the **CQC**.
Question 65: During a suicide risk assessment, a 46-year-old man with depression describes detailed thoughts about hanging himself. He has researched methods online and identified a location. However, he has not purchased any materials. He lives alone but has regular contact with his adult son. Which classification best describes his current level of suicidal ideation?
- A. Passive suicidal ideation
- B. Active suicidal ideation with plan but without intent (Correct Answer)
- C. Active suicidal ideation with plan and intent
- D. Suicidal intent without ideation
- E. Non-suicidal self-harm ideation
Explanation: ***Active suicidal ideation with plan but without intent***- The patient has developed a **specific method** (hanging) and identified a **location**, which constitutes a plan, classifying the ideation as **active with a plan**.- The absence of **preparatory actions** (not purchasing materials) or explicit statements of immediate resolve indicates that while a plan exists, **intent** to act on it immediately has not been established or is not clearly present.*Passive suicidal ideation*- This involves a **desire to die** or a wish to not wake up without any active thoughts of self-harm or taking action.- This patient's **detailed research** of methods and identification of a specific location moves him beyond passive ideation.*Active suicidal ideation with plan and intent*- This classification requires both a **concrete plan** and clear evidence of **intent**, often demonstrated by preparatory behaviors or a strong stated desire to act.- The patient's lack of **purchasing materials** suggests a lack of immediate or firm intent, distinguishing it from this more severe classification.*Suicidal intent without ideation*- This implies an impulsive act to end life without prior **conscious thoughts** or planning.- The patient clearly describes **detailed thoughts** and research, demonstrating significant ideation and planning.*Non-suicidal self-harm ideation*- This refers to thoughts of inflicting **physical damage** to the body (e.g., cutting) without the goal of ending one's life.- The patient specifically mentions **hanging**, which is a highly lethal method intended to result in **death**, not just self-injury.
Question 66: A 79-year-old man with moderate Alzheimer's dementia (MMSE 13/30) requires urgent surgery for a perforated bowel. He repeatedly refuses consent, stating 'I want to go home now'. His wife reports that 6 months ago, before his dementia worsened, he told her he would 'never want surgery' if he became confused. He has not made a Lasting Power of Attorney or Advance Decision to Refuse Treatment. What is the correct legal basis for proceeding with the surgery?
- A. His wife can provide consent as next of kin
- B. His previously expressed wishes must be followed and surgery should not proceed
- C. Surgery can proceed under the Mental Capacity Act 2005 in his best interests (Correct Answer)
- D. Surgery can proceed under common law doctrine of necessity
- E. Detention under Section 2 of the Mental Health Act is required to authorize surgery
Explanation: ***Surgery can proceed under the Mental Capacity Act 2005 in his best interests*** - When a patient lacks **capacity** to consent to urgent, life-sustaining treatment, the **Mental Capacity Act 2005 (MCA)** allows clinicians to act in the patient's **best interests**, considering clinical needs, the patient's past wishes, and family input. - While the patient's previous verbal statements about not wanting surgery if confused are relevant to the best interests assessment, they do not constitute a legally binding **Advance Decision to Refuse Treatment (ADRT)**, which for life-sustaining treatment must be written, signed, and witnessed. *His wife can provide consent as next of kin* - In UK law, **next of kin** has no legal authority to provide or refuse consent for medical treatment on behalf of an adult, regardless of their capacity. - Only an individual appointed with a **Lasting Power of Attorney (LPA)** for Health and Welfare would have the legal authority to make such decisions for a person lacking capacity. *His previously expressed wishes must be followed and surgery should not proceed* - Informal verbal expressions of wishes, while important, are not automatically legally binding, especially when they lack the formal requirements of an **Advance Decision to Refuse Treatment (ADRT)** for life-sustaining treatment. - In this **acute life-threatening emergency** (perforated bowel), the clinical necessity for survival typically takes precedence over non-binding past verbal statements in a best-interest determination under the MCA. *Surgery can proceed under common law doctrine of necessity* - The **common law doctrine of necessity** has largely been superseded by the comprehensive statutory framework of the **Mental Capacity Act 2005** for patients who lack capacity. - While necessity might still be invoked in immediate, extreme emergencies where the MCA cannot be practically applied, the MCA provides the appropriate formal legal basis for decisions made in a hospital setting for patients lacking capacity. *Detention under Section 2 of the Mental Health Act is required to authorize surgery* - The **Mental Health Act (MHA)** is specifically designed for the assessment and treatment of **mental disorders**, not for authorizing treatment for primary physical health conditions like a perforated bowel. - Even if a patient is detained under the MHA, physical health treatments for those lacking capacity still fall under the provisions of the **Mental Capacity Act**.
Question 67: A 41-year-old woman with a history of emotionally unstable personality disorder presents to the Emergency Department following superficial cuts to her forearms. She states she did this to 'feel something' after an argument with her partner. She denies any wish to die and says she feels better now. Her physical injuries are minor and do not require admission. What is the most appropriate approach to managing her suicide risk in this situation?
- A. Discharge with routine community mental health team follow-up
- B. Conduct a thorough risk assessment focusing on intent and context (Correct Answer)
- C. Arrange urgent psychiatric admission as she has engaged in self-harm
- D. Discharge with crisis team follow-up within 24 hours
- E. Refer to liaison psychiatry but discharge if they cannot attend immediately
Explanation: ***Conduct a thorough risk assessment focusing on intent and context*** - Every patient presenting with self-harm, regardless of stated intent, requires a comprehensive **biopsychosocial assessment** to evaluate current **suicidal intent**, protective factors, and the context of the act. - For individuals with **Emotionally Unstable Personality Disorder (EUPD)**, self-harm is often a coping mechanism for **emotional dysregulation** rather than a direct attempt to die. However, a formal assessment is crucial to accurately determine the current level of risk and guide appropriate management.*Discharge with routine community mental health team follow-up* - Discharging a patient who has self-harmed without a **comprehensive risk assessment** is clinically unsafe and violates established guidelines for managing self-harm presentations. - **Routine follow-up** may be insufficient if the assessment reveals **acute stressors**, escalating risk factors, or a need for more intensive support, which cannot be determined without assessment.*Arrange urgent psychiatric admission as she has engaged in self-harm* - **Psychiatric admission** is not automatically indicated for all instances of self-harm; it is reserved for situations of **imminent risk to life** or severe unmanageable mental health crises. - For patients with EUPD, unnecessary admission can sometimes be **counter-therapeutic**, fostering dependency and potentially hindering the development of independent coping strategies.*Discharge with crisis team follow-up within 24 hours* - Deciding on a specific level of follow-up, such as crisis team involvement, should only occur **after a thorough risk assessment** has been completed. - Prematurely determining the post-discharge plan bypasses the critical step of understanding the patient's current **mental state**, triggers, and overall risk profile.*Refer to liaison psychiatry but discharge if they cannot attend immediately* - Discharging a patient who has self-harmed before they have been properly assessed by **liaison psychiatry** or a suitably trained mental health professional constitutes a failure of **duty of care**. - The patient must remain in a safe environment within the Emergency Department until a comprehensive **psychosocial assessment** can be performed to formulate an appropriate and safe discharge plan.
Question 68: According to the Mental Capacity Act 2005, which one of the following statements correctly describes the principle regarding the timing of capacity assessment?
- A. Capacity assessment should only be performed when there is clinical evidence of cognitive impairment
- B. Capacity must be assessed separately for each specific decision at the time that decision needs to be made (Correct Answer)
- C. Once a person is deemed to lack capacity, this status applies to all future decisions
- D. Capacity assessment is valid for 6 months unless the person's condition changes
- E. A person who lacks capacity for one type of decision lacks capacity for all decisions
Explanation: ***Capacity must be assessed separately for each specific decision at the time that decision needs to be made*** - Under the **Mental Capacity Act 2005**, capacity is considered **decision-specific** and **time-specific**, meaning an individual may have the ability to make some choices but not others. - Assessments must occur at the **specific moment** a decision is required, accounting for **fluctuating capacity** seen in conditions like delirium or dementia. *Capacity assessment should only be performed when there is clinical evidence of cognitive impairment* - The Act starts with the statutory principle that a person must be **assumed to have capacity** unless it is established otherwise, regardless of a medical diagnosis. - While **impairment of the mind or brain** is part of the diagnostic stage, an assessment is triggered by the **functional inability** to make a specific decision when needed. *Once a person is deemed to lack capacity, this status applies to all future decisions* - Capacity lacks a permanent "status"; it must be reviewed because an individual's **cognitive state or circumstances** may improve or fluctuate over time. - The practitioner must always consider if the decision can be **delayed** until a time when the person might **regain capacity**. *Capacity assessment is valid for 6 months unless the person's condition changes* - There is no **fixed duration** or "expiry date" for a capacity assessment under the law, as it is tied to an **individual event**. - A new assessment is required for every **new or distinct decision**, even if a previous assessment was conducted recently for a different matter. *A person who lacks capacity for one type of decision lacks capacity for all decisions* - This is incorrect as the Act rejects **"blanket" assessments**; capacity is determined based on the **complexity** of the specific task at hand. - For example, a patient may lack capacity to consent to **complex surgery** but still possess the capacity to decide **daily tasks** or basic personal care.
Question 69: A 34-year-old man with recurrent depression is reviewed in the psychiatric outpatient clinic. He describes ongoing suicidal thoughts but denies any specific plans. When asked about protective factors, he mentions his elderly mother who depends on him for care. During the consultation, he becomes tearful when discussing his mother's deteriorating health. Which aspect of this presentation most significantly increases his suicide risk?
- A. Becoming emotional during the consultation
- B. Having ongoing suicidal thoughts without a plan
- C. The potential loss of his role as carer (Correct Answer)
- D. His diagnosis of recurrent depression
- E. The stress of caring for an elderly parent
Explanation: ***The potential loss of his role as carer*** - The patient identifies his mother and his caregiving duties as his primary **protective factor**; if this role is lost due to her deteriorating health, his acute risk of suicide increases significantly. - Losing a **reason for living** creates a high-risk transition period where a previously stable patient may act on existential hopelessness. *Becoming emotional during the consultation* - Tearfulness in a psychiatric consultation is a **normal emotional response** to discussing a distressing topic like a mother's failing health. - Emotional expression is not a recognized **static or dynamic risk factor** for suicide and can sometimes facilitate better therapeutic engagement. *Having ongoing suicidal thoughts without a plan* - While **suicidal ideation** is a general risk factor, the absence of a **specific plan** or intent suggests a lower immediate risk compared to the loss of protective factors. - Chronic ideation is common in recurrent depression and represents a **baseline risk** rather than a catalyst for an acute crisis. *His diagnosis of recurrent depression* - **Recurrent depression** is a known **static/background risk factor** that increases long-term susceptibility to suicide. - However, a pre-existing diagnosis does not explain an **acute elevation in risk** as effectively as the imminent threat to personal support systems. *The stress of caring for an elderly parent* - While **caregiver burden** can contribute to depressive symptoms, in this specific case, the patient explicitly labels it as a **protective factor** rather than a stressor. - The perceived **sense of responsibility** to others is one of the strongest modifiers that prevents people from acting on suicidal thoughts.
Question 70: A 68-year-old woman with a 2-year history of Alzheimer's dementia (MMSE 19/30) refuses to take her newly prescribed anticoagulation for atrial fibrillation. When asked why, she states she 'doesn't like taking tablets' but cannot explain the risks of not taking the medication or the benefits of taking it. She can repeat back what you have told her about the medication. What is the most appropriate next step in assessing her capacity to refuse this treatment?
- A. Accept her refusal as she has capacity to make this decision
- B. Arrange for a psychiatrist to assess her capacity
- C. Assess whether she can use and weigh the information to make a decision (Correct Answer)
- D. Consider her to lack capacity as she cannot retain information long-term
- E. Prescribe the anticoagulation in her best interests as she lacks capacity
Explanation: ***Assess whether she can use and weigh the information to make a decision*** - Under the **Mental Capacity Act (2005)**, a person must be able to **understand**, **retain**, **use and weigh** information, and **communicate** their decision. - Although she can repeat the words back (retention), she has not yet demonstrated the ability to **weigh the risks and benefits** or the consequences of refusing anticoagulation. *Accept her refusal as she has capacity to make this decision* - It is premature to conclude she has capacity simply because she can communicate a preference; her inability to explain risks suggests her **processing of information** is impaired. - Capacity is **decision-specific** and must be fully tested against all four functional criteria before a refusal is accepted in an impaired patient. *Arrange for a psychiatrist to assess her capacity* - A **capacity assessment** should be performed by the **treating clinician** proposing the intervention (e.g., the GP or cardiologist) rather than automatically deferring to a specialist. - Referral to a **psychiatrist** is usually reserved for complex cases where there is doubt about an underlying mental illness or cognitive symptom overlap. *Consider her to lack capacity as she cannot retain information long-term* - Capacity only requires the person to retain information for a **sufficient amount of time** to make the specific decision at hand. - Because she can **repeat back** the information, she has demonstrated at least short-term retention, so this criterion is not necessarily failed. *Prescribe the anticoagulation in her best interests as she lacks capacity* - A **best interests** decision can only be made after a formal assessment has proven the patient definitively **lacks capacity**. - Skipping the assessment step violates the principle that a person must be **assumed to have capacity** unless proven otherwise through the functional test.
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