MDU advice

The medico-legal adviser clarified that the procedure was an elective one and could be safely postponed whilst further information was obtained, so an appropriate decision could be made in accordance with the Mental Capacity Act 2005 and an alternative plan considered if necessary.

The anaesthetist had quite rightly started with an assumption that the patient had capacity (despite the diagnosis of dementia) but had established that the patient lacked capacity to accept or refuse the use of blood products. She had also confirmed that there was no known advance decision to refuse treatment, nor was there a relevant power of attorney. The patient's only relative, his granddaughter, was driving to the hospital and was expected to arrive within the next two hours.

The adviser suggested that the procedure was delayed until after the anaesthetist had spoken with the granddaughter, to confirm whether or not the patient was indeed a Jehovah's Witness and would have refused blood products. However, the granddaughter could not make the decision for the patient, and as there was no relevant advance decision or power of attorney, the clinical team were left in the position of having to reach a 'best interests' decision.

In order to do so they would need to try and establish what they could about the patient's previously expressed views on the matter and the views of also important of family members or carers. The adviser also explained that it would be important to make sure that the assessment of capacity and these discussions, as well as the views of the relevant members of the medical team, were documented.

Patient consent: an anaesthetist's dilemma

Patient consent: an anaesthetist's dilemma