Capacity to consent

Capacity to consent

Capacity to consentCapacity to consentThe ability of an adult to understand, retain, weigh and communicate a decision about their own treatment or support. Different jurisdictions define this in law in different ways — apply your local framework. SPLWs should know when to seek a formal capacity assessment from a qualified clinician. is the ability of an adult to understand, retain, weigh and communicate a decision about their own treatment or support.

Most jurisdictions express the principles of capacity assessment in law — for example through specific statutes that define when capacity should be presumed, when it must be supported, and what counts as a "best-interests" decision when an adult lacks capacity for a particular decision. The principles below are widely shared. Apply your jurisdiction's framework in practice.

Five widely-shared principles

1. Presume capacity. Every adult is presumed to have capacity to make their own decisions unless there is a clear reason to think otherwise.
2. Give all practicable help before deciding someone lacks capacity. This includes adapting communication, picking the right time and place, using interpreters or advocates.
3. People have the right to make unwise decisions. Choosing to do something risky is not the same as lacking capacity.
4. Anything done for a person who lacks capacity must be in their best interests.
5. The least restrictive option that meets the need should be used.

Capacity is decision-specific and time-specific

A person can have capacity for some decisions and not others, and capacity can fluctuate. Someone with dementia may be able to decide what to have for lunch but not be able to decide whether to sell their house. Someone in mental health crisis may temporarily lack capacity for a decision they would normally make easily.

What this means in practice for SPLWs

• When supporting someone whose capacity may be in question, document what you did to support their decision-making — plain language explanations, multiple sessions, involvement of trusted family or advocate.
• If you believe a person lacks capacity for a significant decision (consent to information sharing, consent to specific support), flag it to your clinical supervisor. A formal capacity assessment is needed; you do not do it.
• Best-interests decisions are made by the appropriate decision-maker in your jurisdiction — usually a clinician or social worker — with input from family, advocates and others who know the person.

Substituted decision-makers and advocates

You may meet people whose decisions are being made by a substitute decision-maker — a person legally appointed to act on their behalf, sometimes for health and welfare, sometimes for property and finances. Where someone has no family or friends to consult, an independent advocate may be appointed. Know who is involved, and respect their role.

The exact legal mechanisms vary by country — power-of-attorney arrangements, guardianship, supported decision-making frameworks. Learn yours.

Read more

• Your country's capacity-to-consent legislation and code of practice
• Your local safeguarding adults board's guidance
• WHISWHIS— World Health Innovation SummitEstablished in 2015 to improve health and wellbeing outcomes through innovation, education and partnerships. Co-developer (with GSPA) of the WHIS Social Prescribing Link Worker programme. Module 5: Safeguarding.

Linked competencies

• Information governance — including consent (Domain 4)
• Obligation to safeguard individuals from harm (Domain 4).