Mr Smith is a 75-year-old gentleman who lives with his wife. He has been registered with the surgery for a number of years and although he has only attended very rarely due to excellent health, he has always sought appropriate care when required. He is attending the surgery today as his wife has contacted you voicing concerns about his deteriorating memory and episodes of confusion, so you have called him in for review. Mr Smith’s cognition has appeared to have deteriorated significantly since you last saw him. You believe he would benefit from an assessment at the memory clinic but he refuses the referral stating that there is nothing wrong with him and his wife is “going mad”.
Points to consider -
Have you presumed capacity or do you have a clear reason to question it? Remember, a diagnosis alone is not sufficient reason to assume a person does not have capacity for a decision.
Have you been able to support Mr Smith in making his decision and maximise his capacity? e.g. Can the decision wait? Is there a time of day that is better for him? Is it possible to see him at home where he would likely be more relaxed?
Does Mr Smith need any help with the information you are giving him? e.g. does he require supporting written information, pictures, more simple language?
Is there any reason to suggest he does not understand the information you are giving him? e.g. Does he look perplexed? Is he able to answer questions appropriately or ask relevant questions?
Is Mr Smith able to retain the information you have given him long enough to weigh up pertinent points and make a decision? e.g. Is he able to explain to you the salient points and give examples of pros and cons of the referral to memory clinic?
Have you any evidence of any previous wishes Mr Smith may have had on this matter? Does he have an advanced care plan in place for this specific decision?
Does the decision need to be made now or can it be revisited with Mr Smith at a later date?
If your assessment concludes that Mr Smith does not have the capacity to agree to the referral is it in his best interest to continue with it or to wait and continue to have further discussions and possible future agreement? Consider any risk factors, his levels of distress now and if the referral goes ahead, impact on relationship with his wife and with yourself.
Case study examples taken from practice and linked to information in the toolkit to give practical examples of different aspects of the Act.