Case Study: Capacity and Consent to medical treatment
Nina is 83 years old and has type 1 diabetes and limited mobility. She suffers from diabetes-related complications including kidney disease. She is able to live independently but receives a weekly home visit from Susan, a home care nurse, for diabetes management. Nina’s daughter Alison visits most days to check on her mother.
When Susan last saw Nina she was in good spirits and positive, but when Susan next visited Nina was upset and said she does not want to take her insulin any more. She tells Susan to go away. Alison was also at Nina’s house. She confided to Susan that she is very worried and that her mother’s decision is completely out of character. She said her mother has not been herself recently, and her behaviour has been odd. When Alison took Nina to a renal specialist appointment Nina was confused about where they were going, and seemed to have forgotten that she had kidney disease. She has been forgetting other things as well, like to lock the front door, and to feed her cat.
Susan asked how long Alison has noticed these symptoms. Alison admitted Nina has become increasingly forgetful for some months, but she wasn’t concerned as she thought it was related to Nina’s age and changes to her medication.
Susan wonders if Nina has a condition which is affecting her memory and ability to make decisions. If so, it may be that she does not truly want to stop taking insulin. Susan consults with her Home Care Manager, who advises her to arrange for Alison to take Nina to the GP as soon as possible. She suggests Alison ask the GP to arrange a capacity assessment for Nina with a qualified specialist, to determine if she has a medical condition that is affecting her memory, and whether she has capacity to make decisions about her treatment.
These facts raise doubts that Nina has the required legal decision-making capacity to make decisions about her medical treatment. If the capacity assessment determines she does not have decision-making capacity, and she does not have an Advance Care Directive which provides a relevant treatment decision, a substitute decision-maker will be required to make future treatment decisions for Nina.