Consent and Decision-Making Capacity Assessment for Health and Social Care TeamsDoing more for somebody is not the safe answer. It is just the error nobody complains about.

Methodology: Thirty-nine original exercises across six formats: sixteen ladder situations, six most-and-least forced choices, six select-every-that-applies exercises, five binary claims, three matching exercises and three ordering exercises. The declared response instruction is behavioural tendency throughout - what are you most likely to do - and one instruction covers the whole form. Construct statement: it measures how closely somebody's handling of a decision matches what that decision warrants, whether they can separate the question of ability to decide from the question of whether the decision is a good one, whose view they treat as evidence of what, and whether their record would be checkable by a reader who was not present. It does not test any country's legislation, any code of practice or any assessment tool, it does not measure clinical knowledge, and it is not a fitness-to-practise judgement about anybody. Scoring is a warranted-level match. Every situation offers the same four levels of how far to go past what the person has said, re-worded for the situation so the answer cannot be found by matching a phrase, and positioned so that each level occupies each slot four times across the sixteen. Credit comes from a four-by-four table whose COLUMNS have identical means over an evenly warranted bank, which is the whole of the design: with credit graded by plain distance the middle levels sit nearer to everything and always consulting quietly becomes the best fixed strategy. With this table every fixed level scores the same total, all four score behind reading the case, and the report demonstrates that on the reader's own answers rather than asserting it. The direction of the error is reported as its own signed number rather than priced into the headline, because a table that pays more for going further trains defensive practice and calls it care; the width of the ladder a respondent actually uses is reported as a third figure. Every other strand is chance-corrected against authored answer priors carried on each option, with the two poles of each forced choice carrying separate priors because a most and a least are two different questions with two different nulls. Each of the four parts carries a three-way placement with its reliability printed, never a number and never a percentile, because no norm group exists. Constructs and sources: the functional, decision-specific and time-specific model of decision-making ability that is common to capacity frameworks internationally and to the MacArthur competence research programme (Appelbaum and Grisso's four abilities - understanding, retaining, appreciating and reasoning, with communication of the choice); the principle that an unwise decision is not evidence of incapacity, which is the most frequently breached rule in audits of real capacity records; the least-restrictive-option principle and the substituted-judgement versus best-interests distinction; the empirical finding that capacity is over-attributed to compliant patients and under-attributed to refusing ones, which is why the refusal situations here are balanced against the agreement ones; research on fluctuating and time-of-day variation in decision-making ability; the documentation literature showing that conclusory notes such as lacks insight are the commonest single fault in capacity recording; McDaniel and colleagues on behavioural-tendency response instructions in situational judgement; and Haladyna, Downing and Rodriguez on plausible distractors and cue control. All exercises are original works; no commercial instrument's items or name is reproduced and no affiliation is implied.