QuestionSBA
QuestionChoice
The patient appears to have the capacity to make decisions in this case. Seeking consent from the patient's next of kin is not the best course of action in this case.
10035994
c
Seek consent to proceed from the patient's next of kin
QuestionChoice
This may be required if there are disagreements regarding whether the patient has capacity, but is unlikely to be the next best step to take.
10035996
e
Seek advice from the hospital's legal department
QuestionChoice
While this would be useful to establish, a lasting power of attorney's decision-making role is only invoked if a patient lacks the capacity to make decisions about their medical treatment. In this case, the patient appears to have the capacity to refuse surgery, so the best course of action is to respect their wishes.
10035995
d
Establish if a lasting power of attorney has been appointed
QuestionChoice
A DOLS application is required when a patient who lacks capacity is being deprived of their liberty (e.g. kept in hospital, subjected to 1-1 nursing or physical restraints) in their best interests. This is not applicable in this case.
10035993
b
Apply for a deprivation of liberty safeguard (DOLS)
QuestionChoice
Despite the patient's Alzheimer's disease, the question stem suggests they have the capacity to decide to not undergo surgery. A detailed assessment would of course be required to confirm this is the case. It is important to remember that capacity is decision and time-specific and that a disorder of the mind/brain does not automatically mean a patient lacks capacity.
10035992
a
Respect the patient's choice
Concept
Chapter
2693
5799
Criteria for assessing capacity in adults
Topic
184
Ethics and Law
19602
Respecting a patient's autonomy is crucial, even in the presence of cognitive impairment, provided they demonstrate understanding and capacity regarding their treatment choices.
An 89-year-old patient with a history of Alzheimer's dementia is admitted to hospital after sustaining a fall at home. A trauma-protocol CT scan shows a displaced left humeral fracture.

The patient is adamant that they do not want to be operated on despite the orthopaedic team's recommendations. They express a strong wish for conservative management and appear to understand the consequences of not having surgery.

What is the most appropriate next step to take?
a