The impact of paranoid (delusional) beliefs on the ability to use or weigh information was part of a recent ruling concerning a man needing a pacemaker to be fitted (he was also under Section 3 of the MHA 1983). Although he understood the relevant information the judge found he lacked mental capacity because: ‘His ability to weigh up the advantages and disadvantages is distorted by a paranoid belief that the authorities are persecuting him.’ The judge ruled it was in his best