A personal decision - medical case study

...the practice invites Miss B for a smear test but, due to her learning difficulties, her mother responds on her behalf...

BACKGROUND: A practice sends out a letter to a 42-year-old patient, Miss B, inviting her to attend for a cervical smear test. Miss B has learning difficulties so her mother responds on her behalf a few days later to say she will not be undergoing the test. GP, Dr H, notes that Miss B has never had a smear before and believes it would be in her best interests to have one now.

However, he is unsure about whether or not he should accept the mother’s response or pursue the matter further. There is no indication in Miss B’s record that her mother (or anyone else) has previously made healthcare decisions for Miss B, nor is there any note of a formal authority to make decisions on her behalf.

He contacts an MDDUS medical adviser for assistance.

ANALYSIS/OUTCOME: An MDDUS adviser tells Dr H that he must first establish whether Miss B is capable of consenting to or refusing this treatment. It would be advisable to invite Miss B to attend the practice, accompanied by her mother if she wishes. Dr H should discuss the issue with Miss B (and her mother, if she attends) and determine whether Miss B understands the treatment being offered, the reasons for the treatment and any potential side-effects or consequences. Miss B must be able to retain the information long enough to make a decision and be able to clearly communicate her decision, with support where necessary.

Should any disagreement arise with the patient’s mother then every attempt should be made to reach a consensus. This might include such measures as seeking a second opinion or involving an independent patient advocate but much will depend on the patient’s capacity. All discussions should be clearly documented in Miss B’s notes.


  • Where a relative/carer seeks to make healthcare decisions for a patient, first check whether the patient has capacity to decide for themselves.
  • Make every attempt to reach a consensus with relatives/carers regarding the healthcare of patients with potential capacity issues.
  • Keep a clear record of all discussions.

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