PART 3: Acting Without Capacity — Best Interests, Restraint & DoLS / LPS
Pro
Covers best interests, lawful restraint, and MCA versus MHA boundaries in emergency care. Essential for high-yield board questions on DoLS safeguards and unlawful ED holding powers.
Audio podcast
Listen on the go — with live captions.
Infographic
High-yield one-pager.
Slide deck
Tight, illustrated review.
MCQs
6 questions available
Easy · 0
Medium · 4
Hard · 2
Mind map
Summary
PART 3: Acting Without Capacity — Best Interests, Restraint & DoLS / LPS
- Core Dilemma: Safely restraining, sedating, and treating an agitated, incapacitous patient in the ED, and distinguishing the Mental Capacity Act (MCA) from the Mental Health Act (MHA).
- Best Interests & Restraint (MCA ss.4–6): Always consult available family/carers regarding the patient's wishes and values (relatives cannot "sign consent" for adults without a valid H&W LPA). Physical or chemical restraint under MCA s.6 is lawful only if: (1) the patient lacks capacity, (2) restraint is necessary to prevent harm to the patient, and (3) it is proportionate to the likelihood and severity of that harm.
- Deprivation of Liberty in the ED (Cheshire West & Ferreira [2017]): While the Cheshire West Acid Test defines a deprivation of liberty as "under continuous supervision and control + not free to leave," the Court of Appeal in Ferreira (and MCA s.4B) confirmed that acute, life-saving physical medical care in Resus/ICU does not require a DoLS authorization before treating.
- MRCEM/FRCEM Exam Trap: The Golden Rule: The Mental Health Act (MHA 1983) ONLY covers treatment for a mental disorder (and direct consequences like self-poisoning under s.63), NEVER unrelated physical illness (like appendicitis or a broken femur). Furthermore, MHA Section 5(2) applies ONLY to admitted inpatients and is completely unlawful in the Emergency Department.