Supporting decision-making and assessing capacity

Use a person-centred approach taking into account will and preferences

Annie is an elderly lady with middle stage dementia. Her husband and carer Dan has become ill due to the stress of caring for Annie. Her adult son Paul is trying to make arrangements for his mother’s future care. Dan is insisting that Annie be kept at home as he believes that it is his duty to care for Annie. Worried about the adverse effect on his father’s health and his refusal to allow carers into their house, Paul explains to Dan that Annie’s own will and preferences have to be taken into account. He suggests that they talk to Annie’s oldest and closest friend Claire to find out if they ever spoke about Annie’s future care.

Claire tells them that she and Annie had discussed this topic fully when Annie had been diagnosed. She says that Annie had told her that while her preference would be to be cared for at home, she did not want that at the expense of Dan’s health. Annie told Claire that she would much rather share their house with carers or live elsewhere and have Dan come to visit her, rather than have him caring for her on his own. When Dan hears this, he agrees to allow carers to come to the house. He also agrees to start looking at nursing homes in case this option is needed in the future.

Comment: This vignette demonstrates that in making an intervention you must adopt a person-centred approach, ensuring that the relevant person’s values, beliefs, will, and preferences are given due regard, as outlined in Section 8(7) of the Assisted Decision-Making (Capacity) Act 2015. This vignette also highlights how the will and preferences of the relevant person can be ascertained from a third party when the relevant person cannot express them themselves, and how they should inform a decision about the relevant person’s care (i.e., an intervention).

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