Capacity and consent

Mental capacity is defined as one’s ability to make informed decisions based on information provided and communicate the decision made to others.

It is often wrongly assumed that all people with learning disabilities do not have the mental capacity to make decisions of their own. 

The Mental Capacity Act (2005) lays out 5 principles to be applied in decision making:

1. a person must be assumed to have capacity unless it is established that he lacks capacity
2. a person is not to be treated as unable to make a decision unless all practicable steps to help him to do so have been taken without success
3. a person is not to be treated as unable to make a decision merely because he makes an unwise decision
4. a decision made under this Act for or on behalf of a person who lacks capacity must be made in his best interests
5. before the decision is made, it is important to ensure that the purpose for which it is needed cannot be effectively achieved in a way that is less restrictive of the person's rights and freedom.

It must be assumed that an adult with learning disabilities has capacity until proven otherwise. The fact that a person has a diagnosis of a learning disability does not mean that they lack capacity to make decisions of their own. It is important that they are give the information required to make informed decision, even if they may seem to be unwise decisions. Adults with learning disabilities can be supported to understand information and communicate their choices through the use of reasonable adjustments.

Reasonable adjustments to aid better understanding and communication can include:

• use of pictures
• use simple words 
• avoid the use of jargons
• illustrations and role plays
• sign language 
• involve a family/carer who is familiar with the communication needs of the person in the process
• allowing plenty of time to communicate and retain information
• check understanding by asking questions.

Best Interest Decisions

If, after all attempts have been made and it is found that the adult with learning disabilities lacks capacity to make informed decisions relating to the intervention required, then a Best Interest decision can made by the professionals involved in the care provision.