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 interests to have the pacemaker and authorised the surgery plus the use of restraint and a deprivation of liberty in an acute hospital if required.
