Mental capacity contradictions

Can an old lady with a documented history of refusal of treatment with an anti-depressant really consent to treatment when she no longer even remembers who her daughter is?

Over the course of the last year Mum’s mobility has deteriorated so much that she essentially can only go out of the house if it is to get into a car and be driven somewhere. She also has a degree of dysphasia which frustrates her, as she loves to chat.

Unsurprisingly, she has become quite down in the dumps, but she has some old-fashioned views about mental health and doesn’t admit to depression although her GP saw fit to refer her to the Community Mental Health Older Adults Team. Mum got on well with the CPN and enjoyed her visits but did state unequivocally that she would not agree to be treated with antidepressants even if a formal diagnosis of depression was made.

So far, so in line with Mum’s categorical refusal to be agree to having carers at home. On that issue, even though lots of people think Mum would benefit from carers (including the Social Work key worker and her GP as well as family & friends), Mum has been entitled to refuse the carers – or so the social work people tell me.

Mum has been hospitalised for a nearly two weeks now, having been admitted with severe constipation. She is more confused than ever and cannot tell me when I visit what has happened to her that day (even though I know she has had physiotherapy, for example). The doctors have explained to me that this ‘delirium‘ is common when elderly people are hospitalised.

This morning the doctor told me Mum definitely can’t come home without an extensive care package. So how are they going to get her to agree to it?

After the first week, during which Mum was often tearful, she was put onto an anti-depressant without anyone consulting me, even though the doctors had had a full history from me in which I told them Mum’s attitude to anti-depressants.

Now, don’t get me wrong, if they had consulted me or my brother, we would have agreed that Mum should be treated, but they say Mum consented. She wasn’t asked in my presence, so I don’t know how the question was put to her. I don’t think she was fit to consent; she doesn’t even know who I am some days.

I think this is an abuse – albeit for the ‘right’ outome- of the capacity to consent rules, and as a carer it leaves me more frustrated than ever about what my role is. It seems that the medics can do whatever they like with impunity when they think it is the right thing to do, while the family carer cannot insist on anything at all – in this case a care at home package – even if it is obvious to all concerned that the person is making a really bad decision.

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