Educational draft · awaiting clinical reviewUse Rapid for revision, not patient-care decisions. Check current national and local guidance and the BNF or BNFC before acting.
2 min synopsisUK scopeSources checked 27 Aug 2026Clinical review pending
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Urgent treatment while capacity is uncertain
Life-threatening illness may require action before delirium resolves, communication is fully restored or legal documents are located, but urgency does not create unlimited authority.
Action: Provide immediate communication and reversible-factor support, define the decision and search for a valid refusal or authorised proxy. If delay would cause serious harm and no binding refusal is known, give only necessary proportionate treatment under the applicable emergency or best-interests framework while verification and senior legal review continue.
Synopsis
Assess whether a person can make one defined decision at the required time after all practicable support, apply the correct jurisdiction's legal test, and distinguish incapacity from diagnosis, detention, communication difficulty or an unwise choice.
Define the exact decision, available options, material benefits and harms, consequences of no action and the time by which it must be made.
Presume capacity and take all practicable steps to support the decision through timing, treatment of reversible factors, interpreter, sensory aids, simple language and communication technology.
In England and Wales, identify an impairment or disturbance of mind or brain and ask whether, because of it, the person cannot understand, retain, use or weigh, or communicate relevant information.
Key red flags
Age, diagnosis, psychosis, detention, intoxication, learning disability, communication impairment or an apparently irrational outcome cannot alone establish lack of capacity.
Investigation priorities
01
Decision and material-information definitionFirst step
Specify the actual options, benefits, harms, no-action consequence and decision deadline.
Management branches
Capacity assessmentSupport first and test one decision
There is a genuine reason to doubt ability for a specific healthcare or welfare choice.
Define the decision, material information and urgency and identify the applicable UK jurisdiction and possible impairment.
Provide practicable communication and clinical support, then ask the person to explain and compare options and communicate a choice.
National guidance is shown before implementation-dependent detail. Typical adult dose examples remain subject to patient factors, contraindications and the live BNF or specialist protocol. Source check completed 27 Aug 2026; clinical approval remains outstanding.