Too confused to consent?

Assessing a patient's capacity and best interests led one member to seek the DDU's advice on finding a way forward.

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The scene

A member contacted the DDU for advice about an elderly patient. The member had concerns that the patient was forgetful, and sometimes appeared to be confused. The patient's son sometimes attended as well but couldn't always make it.

The DDU member wanted advice about how to approach the situation, particularly around the patient's capacity to provide valid consent.

DDU advice

The member was advised to seek clarity on the patient's capacity to consent and to document this carefully. If the patient lacked capacity, any proposed treatment would have to be in the patient's best interests, and it would be wise to check the views of relatives and carers and consider involving a senior colleague for a second opinion before proceeding.

A meeting with the patient and their relative would be helpful so a plan could be made for care going forwards, which might also include consulting the patient's GP. If the patient had capacity, it would be important to get their consent to involve others in their care.

Our adviser suggested checking for any existing advanced decisions or lasting power of attorney (LPA). The member was advised to document all discussions and decision-making processes carefully.

Learning points

The critical issue in this case is the patient's capacity to consent. When assessing a patient's capacity to decide for themselves, use the following two-stage test of capacity.

  • Does the person have an impairment of the mind or brain, or is there some sort of disturbance affecting the way their mind or brain works? (It doesn't matter whether the impairment or disturbance is temporary or permanent.)
  • If so, does that impairment or disturbance mean the person is unable to make the decision in question, when it needs to be made?

Remember that a patient must be able to:

  • understand information relevant to the decision (for example, the nature of proposed treatment and its consequences)
  • retain the information provided to them
  • weigh up the information as part of their decision-making process
  • be able to communicate their decision.

The patient only needs to be able to retain the information for long enough to weigh it up, decide how they want to proceed and communicate the decision. They do not need to be able to retain it for the duration of the course of treatment.

For a patient lacking capacity, it's important to determine if treatment is in a patient's best interests. This often means involving others and considering any previously expressed or present wishes of the patient, as well as their lifestyle, financial situation, religious, spiritual or philosophical views, and so on.

Any advanced decisions made by the patient when they had capacity to consent should be followed.

A person with a valid LPA for the patient's health and welfare can authorise dental decisions on the patient's behalf it the patient lacks capacity to consent. If you want to check if an LPA is valid, please call the DDU for advice.

If a patient lacks capacity and no written authority exists, it would be wise to seek the views of an independent mental capacity advocate or consult with others for a second opinion. This would be especially important for any irreversible treatment. Crucially, any treatment should at all times be undertaken with the patient's best interests at heart.

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This page was correct at publication on . Any guidance is intended as general guidance for members only. If you are a member and need specific advice relating to your own circumstances, please contact one of our advisers.