- Jan 23, 2019
Thanks for your question.Question 2: My mum is suspected of having lung cancer. Her previous battles with cancer have always involved invasive surgery, and I am not sure she’d be well enough to cope. I am worried about the effects of chemo and radiotherapy. Mum doesn’t understand or remember 99% of what is said to her in consultations, so where do I stand in terms of ‘consent’ for investigations or treatments which are proposed?
There should always be an assessment of your mother’s mental capacity regarding the decision of any/each treatment being considered and discussed with your mother and family/loved ones. In order to have capacity she should be able to do each of the following four things:
1) Understand the implications of treatment and why it is required;
2) Retain the information given (this only has to be for a short period of time whilst being given the info or demonstrating she is able to weigh up risks and benefits - not an hour or more later);
3) Weigh up the risks and benefits of having treatment or not having treatment;
4) Be able to communicate her decision and understanding by various methods. E.g reading, writing, signs, pictures etc.
If she fails on any one of these 4 then she should be deemed as having no mental capacity for that specific decision and therefore a Best interest meeting should be held to discuss the options and way forward.
That meeting should include all those that know her well including professionals and friends/family and take into consideration her past wishes, whether it seems an unwise decision (we sometimes all make them in life and that should be considered as it may seem unwise to us but not them), and consider alternate options of treatments or the do nothing option.
If someone has Lasting Power of Attorney (LPA) for health (not finances) and the person is deemed to lack mental capacity regarding a certain decision then that appointed person should be listened to and their view acted on unless the Consultant feels the said person is at risk and the Consultant feels unhappy about performing the treatment .
The LPA for health needs to have been registered with the court and evidence of this shown to the relevant Consultant. It may be the family member who makes the decision after discussion with the treating team, however it is usually good practice to consider each individuals thought and what they personally feel is the best outcome.This can then be used to guide a decision.
If a person does have a LPA for health than it does not have to particular be a best interest meeting as they will have to right to make the decision but a planning meeting is often helpful to discuss decisions to be made. The above meetings should be documented and everyone given a copy of the decision made.
If a person with dementia can consent to treatment and this is evidenced they can sign the consent form. If not then a relative/nok should sign an alternative consent form along with 2 medics. The end outcome should really be about the impact of Quality of Life on that person and treatment isn’t always the best option if it impacts on that. This includes the person’s emotional, spiritual, psychological, physical and functional impact.
This link from the NHS website has further information on consent to treatment and capacity:
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