Clinical Scenario - 3:
Bess is a 78 year old widow who lives with her son and
daughter-in-law. Bess has dementia, is very hard
of hearing, and her ability to understand information
varies on a day-to-day basis and depending on the circumstances.
In the last two weeks Bess has collapsed twice. Bess’s
GP thinks she may need a pacemaker so refers her to a
cardiologist for an assessment. Before the appointment
arrives, she collapses at home. An ambulance is
called, but when it arrives she has recovered and refuses
to get into the ambulance.
Exercise:
You are a member of the ambulance crew what do you do?
The senior paramedic makes a best interests decision
that Bess should go to hospital and persuades Bess to
get into the ambulance. At A & E, Bess is seen
by a cardiologist who confirms that she needs a pacemaker.
She remains confused and is becoming increasingly distressed.
She clearly does not fully understand what a pacemaker
is and what the procedure will involve, even though staff
are taking her hearing impairment into account.
Exercise:
How would you assess capacity?
Who would you involve in the assessment?
Who might you seek advice from?
Discussion
Capacity varies across specific decisions and across
time. As Bess is not confused all the time, if possible
it would be good to delay the procedure until Bess is
less confused and able to make the decision herself.
If this is not possible it may be necessary to assess
Bess’s capacity. It is likely that Bess’s
GP and her son will be involved, as they are the people
who know Bess well.
Source: Adapted from Code of Practice 2007 |
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