Psych CASC / OSCE · Consultation-liaison — capacity and consent
Assess capacity for treatment refusal — CASC communication station
MRCPsych/FRANZCP-style CASC: disclose information in plain language, use teach-back, assess four abilities, explore voluntary refusal vs incapacity, outline supports and pathways, involve family with consent, and close with a clear plan.
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Station brief
Format. Communication station, approximately 7–10 minutes active time after reading. You are the psychiatry registrar called by the medical team. [1]
Candidate instructions. Assess the person’s decision-making capacity regarding IV antibiotics for community-acquired pneumonia. Explain the condition and treatment in accessible language. Use teach-back. Explore reasons for refusal. If capacity appears present, respect a voluntary informed refusal while ensuring they understand consequences. If capacity appears impaired, explain supports, possible need for emergency treatment or a substitute decision pathway under local law (no invented section numbers), and involve supports with consent. Avoid coercion and humiliation. [1][2]
References3ShowHide
- [1]Appelbaum PS Clinical practice. Assessment of patients' competence to consent to treatment N Engl J Med, 2007.PMID 17978292
- [2]Sessums LL, Zembrzuska H, Jackson JL Does this patient have medical decision-making capacity? JAMA, 2011.PMID 21791691
- [3]Buchanan A Mental capacity, legal competence and consent to treatment J R Soc Med, 2004.PMID 15340019