the House of Lords discussed the ability of young adults consenting to medical
treatment. In the Lords' opinions, the question of competence was linked to the
individual's ability to understand and be of sufficient maturity to make decisions
on treatment. InRe T %adult: refusal of medical treatment)#1992) the courts did not
investigate the meaning of capacity in any great depth stating that [w]hat is required is that the patient knew in broad terms the nature and effect of the procedure to which consent #or refusal) was given' [26]. The court went on to state that the medical practitioner had a duty to give the patient appropriately full information as to the nature of the treatment and the likely risks of treatment which does, to a limited degree, expand upon the concept ofbroad terms'. Sub-
sequently, in the case ofRe C %adult: refusal of treatment)#1994) the court adopted
atest requiring that the patient must sufficiently understand the nature, purpose and likely effects of the proffered' treatment. In so doing, the judge adopted a proposal by an expert witness that the decision making process should be divided into three stages:first, comprehending and retaining treatment information,
second, believing it and third, weighing it in the balance to arrive at choice'.
This test for capacity has been adopted by the Code of Practice, but with a little
more by way of explanation:
`15.10 An individual is presumed to have the capacity to make a treatment
decision unless he or she:. is unable to take in and retain the information material to the decision
especially as to the likely consequences of having or not having the treatment;
or
. is unable to believe the information; or
. is unable to weigh the information in the balance as part of a process of
arriving at the decision.'
The Code of Practice also makes it clear that capacity can be variable, and so
should be assessed at the time the treatment is proposed [27]. It is also important
to remember:
`Mental disorder does not necessarily make a patient incapable of giving or
refusing consent. Capacity to consent is variable in people with mental disorder
and should be assessed in relation to the particular patient, at the particular
time, as regards the particular treatment proposed.' [28]The nurse's involvement may either be to assist in an assessment of a person's
competence to make a treatment decision or to decide whether there is sufficiently
clear guidance available to act on the basis that the person is not competent. In the
first scenario, nurses are being asked to proffer independent views from the pro-
fessional perspective on the matters raised by the definition of competence quoted.
In the second, nurses need to be sure that there is an indication that the person is
incompetent so that the treatment in which they are to engage is justified without
the patient's consent. Nurses may not always be involved in assisting in an
assessment of competency #and certainly it will not include all nurses working
with a particular patient). All nurses must, however, be able to check the records to
see whether the patient is regarded at the time of the treatment as being not
168 Nursing Law and Ethics