Healthcare Professionals and Supporting decision-making and assessing capacity
Only assess capacity to make a decision if an intervention is considered necessary
Tina has advanced dementia and anxiety. She lives at home with her daughter Mary who is caring for her. Tina has arthritis of her hip and takes medication to treat the hip pain. Her GP, Dr Buckley, strongly recommends hip replacement surgery to stop the pain, however, Tina could continue taking medication instead of the surgery option.
Mary attempts to discuss the option of surgery with her mother on several occasions. Tina refuses to engage in this discussion, saying she does not want surgery but not giving any reasons for her decision. She tells Mary that she wants to continue taking her medication for her hip pain. Mary has doubts about her mother’s capacity to agree to or to refuse the surgery.
Mary then discusses her doubts with Dr Buckley regarding her mother’s decision-making capacity in relation to the treatment options. They both agree that it would not be reasonable or practical to seek a court order to force Tina to undergo surgery. While surgery may preserve Tina’s mobility, it may not guarantee it, and surgery may also increase her anxiety. They acknowledge that Tina has expressed a clear preference for continuing to take medication. Dr Buckley documents the rationale for not proceeding with a surgical intervention in this case and continues to provide medical treatment to Tina for her arthritis.
Comment: This vignette shows that an intervention should only be made if it is considered necessary, as outlined in Section 8(5) of the Assisted Decision-Making (Capacity) Act 2015. It also shows that if an intervention is considered unnecessary, then an assessment of the relevant person’s capacity to make a decision about the proposed intervention is also not necessary and should not be carried out, as described in the code of practice for supporting decision-making and assessing capacity.