Respecting the right to make ‘unwise’ decisions

A short film depicting scenes in a domestic setting between an older man and his domiciliary care worker. The film introduces the principles of the Mental Capacity Act in relation to a financial decision.

The film portrays Raymond, a man in his 80s and recently diagnosed with dementia, and Wendy his paid care worker. The setting is Raymond’s flat. Wendy visits daily to provide Raymond with practical support to manage at home. The context of the drama is whether Raymond has capacity to make a decision about spending 50 pounds on lottery tickets.

Despite Wendy’s efforts to engage him in conversation, Raymond remains largely silent until she goes to leave. He then becomes animated about the lottery and asks her to buy 50 pounds worth of ‘lucky dip’ tickets. Initially Wendy’s response lacks respect for Raymond’s request. After further discussion, Wendy decides that Raymond has capacity to make what others might think an ‘unwise decision’.

While supporting Raymond to make his own independent decision, Wendy records the decision to comply both with the MCA and good record-keeping practice. The final scenes show Raymond enjoying himself as he checks his tickets against the results.

Actors have been used in this short film.

Messages for practice

  1. Learning support materials are available to accompany the film and will prove an invaluable training aid when used together with the film. Click on the link on the right-hand side to open the learning support materials.
  2. People with dementia should be supported to remain as independent as possible and to continue to enjoy their usual activities.
  3. The starting point of the MCA is that it should be assumed that anyone (aged 16 or over) has full legal capacity to make decisions. This is known as the ‘right to autonomy’.
  4. People cannot be assumed to lack capacity because of age, appearance, condition or behaviour.
  5. People should receive support to help them make their own decisions. Before concluding that someone lacks capacity to make a particular decision, it is important to take all possible steps to try to help them reach a decision [principle 2].
  6. People have the right to make decisions that others might think are unwise and should not automatically be labelled as lacking the capacity to make a decision [principle 3].
  7. The MCA is intended to assist and support people who may lack capacity and to discourage anyone who is involved in caring for someone who lacks capacity from being overly restrictive or controlling [principle 5].
  8. But the MCA also aims to balance an individual’s right to make decisions for themselves with their right to be protected from harm if they lack capacity to make decisions to protect themselves.

Who will find this useful?

This film is aimed at front-line care staff, particularly home carers. As well as domiciliary staff, it is relevant for other people who provide care on a daily basis for people who may lack capacity and therefore must comply with the Act. It will also be of interest to managers of care services, commissioners and others who work with older people, to service users and friends and family of people who need care.