Arthur – scenario for training

Mental Capacity Act workbook

Commissioned by, and hosted here on the MCA Directory on behalf of, the members of the NHS Eastern Region Safeguarding Adult Forum facilitated by Eleanor Sherwen & Sarah Robinson.

View here online or order a DVD or workbook

Learning outcomes

For participants to recognise that

Arthur’s story

Arthur is 68 years old and worked as a postman for most of his working life. Arthur has been living on his own in a Local Authority flat for 15 years since the death of his wife. He is very lonely and socially isolated. He has always been a drinker but has now taken to drinking at home. His neighbours look in from time to time but are put off by his poor personal hygiene and the state of the flat. Over the past couple of years, a group of mainly younger men from the local area have started to use Arthur's flat as a place to “crash out” when drinking and there is some casual drug usage. Arthur is only too pleased to have their company.

One Saturday afternoon a neighbour heard a loud thud and the door being ajar, looked inside to find Arthur sprawled on the floor. Having failed to wake him the neighbour called for an ambulance and the crew are now in attendance.

Current decision making issues for the professionals involved

The professional dilemma for the ambulance crew is where does their duty of care start and stop in a situation where the person appears to be under the influence of alcohol, drugs and is experiencing hallucinations. The challenge for professionals is, when the person is sober they are capacitated, where someone makes an unwise decision this needs to be respected.

At what point is the personal safety of the ambulance crew of greater importance than remaining in the immediate environment with Arthur?

The ethical decision

The dilemma for the professionals is about making immediate decisions about Arthur’s need for medical treatment away from his residence. Does the presumption of capacity outweigh any question over his ability to make decisions about his immediate medical needs? Is there any evidence that would suggest the ambulance crew should assess Arthur’s capacity to make decisions? Could they act in his best interests and take him to an Accident and Emergency Department for assessment?