Reflecting on values and bias in mental capacity decision-making

Good communication

Good communication should empower patients/services users within the assessment process, and empowerment is one of the six safeguarding principles detailed in the Care Act 2014 (s42). Health care professionals often work in disempowering environments, and there is sometimes a lack of clarity about who is the responsible decision-maker. This absence of personal knowledge of the individual can mean that assessments may be based on the patient’s diagnosis rather than on their specific needs. Nurses are in daily contact with the patient and may be best placed to assess capacity, but they are often excluded due to a lack of specialist knowledge and seniority.

Health professionals can empower patients through the ‘presumption of person-led decisions and Informed consent’ which means not ma king assumptions about capacity to consent based on age, appearance or medical condition and encouraging the person to participate as fully as possible. As nurses are continuously involved in decision making regarding patient care and treatment it is important to understand the principles of Informed consent and the complexity of gaining consent. Informed consent is underpinned by the fundamental ethical principle of the right of self determination.

You need to be aware of power imbalances and professional roles and identity which can suppress the patient’s voice within the assessment process 

It is therefore important to develop awareness of socially prescribed roles and imbalances of power and status that take place in interactions between the  professional and patients/service users. 

Power Relations

Professionals have social and cultural capital invested in their professional roles which give them power within the fields of health and social care practice, particularly in terms of statutory interventions linked to MCA and Best Interest Decisions. At the same time certain individuals and groups can be marginalised by their life circumstances (for example through  poverty, lack of educational opportunities or poor health) or by aspects related to their age, gender, sexuality, ethnicity, disability, etc.

Power imbalances can suppress the patient’s voice within the assessment process. It is therefore important for practitioners to develop awareness of socially prescribed roles and imbalances of power and status that take place in interactions between professional  and patients/service users.