Can a capacity assessment for medical reasons ever be done without the patients knowledge?

[autonomyagain]

Or would the patient know as they’d have to attend for tests etc?

I assume it would be documented in notes too?

Can these ever be done in a less formal way by a gp just about one issue or is it always a formal assessment that then removes autonomy for everything not just one thing ?

Have you access to the notes of the procedure itself? I know you may not want to discuss the actual procedure on here but I’m perplexed as to how they could do a procedure on an 18 year old against your consent??have you been in contact with PALS at the hospital to get support around accessing more info, the reasons why the Dr. decided to proceed against your consent should be very clearly documented. I know when I was working in the 90’s with elderly people I was very unhappy on a number of occasions where family requests compromised the patients own autonomy ,often around sharing info eg about cancer diagnosis… but I was fully aware of the importance of consenting a patient for treatment at that time.

Yes - it’s very clear that I was ignored when expressing my wishes and saying I didn’t want to proceed . It was documented how my mother was the one to decide and there is also evidence showing how they ignored coercion from her on multiple occasions.

The only piece of information my mother gave me was admitting she had an appt with the gp on her own to discuss it/me then an appt was made where I had to attend with her. She maintained she didn’t ‘break any rules’ saying she spoke and the gp listened and he also doors do anything wrong as he didn’t talk about me but just heard her out

doors - didn’t

I'd be seeing a solicitor if it was me to be honest. Whatever it was they did it doesn't sound right at all!

I tried back when I obtained my notes. Nobody wanted to touch the case. I was told it was too long ago (even though the time limit doesn’t count I think it starts from the point you know harm had been done?)
Others just wouldn’t get involved so wouldn’t give me the information as to whether this was even legal so I feel as if I can’t get the answers I need

OP can you clarify, did you return to the hospital willingly the following week for the procedure?

Capacity is decision and time specific:

Capacity is determined by:
showing an understanding of information pertinent to the decision,
Remembering the information for long enough to make a decision
showing that you can weigh up the options I.e the pros and cons of proceeding with treatment or no treatment
Communicating your decision

Capacity assessment allows for a person to make a "unwise" decision

No the first week I refused and was shouted at by a nurse that I was upsetting other patients by causing a fuss. I’m my notes it was recorded I stated I did not want to have the procedure.
They wrote as per my mothers wishes to tell me to go home and reconsider and they’d book me back in for the following week.

I was then subjected to a week at home of imprisonment. I was threatened what would happen if I didn’t go back the next week.

I had a plan to fake illness on the day assuming they would cancel it. This didn’t work. I told them I was being forced. I tried to not sign the form but when the dr was not in the room my mother threatened me. As soon as it was fined she said ‘now nobody can say it wasn’t your decision’ They did nothing. I had the first part of the procedure (reversible if done quick enough) but quickly Changed my mind and called the dr back but they refused to do what I asked to reverse that and put in my notes that I had asked for a specific thing to be done but then added that I was +++distressed so they hadn’t actually understood me and it was after that I was taken to theatre very quickly

I think it was a combination of professionals turning a blind eye / complying with my mother and allowing her the final say plus ignoring what she was doing.

Maybe I shouldn’t keep going over it I know it was wrong but it just bothers me was this legal or not. It doesn’t change anything but I just need to know if that makes sense

@TimeSlipMushroom op incident predates MCA framework

@autonomyagain this is a very old paper on consent (well before your time!) and is talking about minors of 16 so the establishment of consent is a very old principle. The sort of situations that I know that were problematic for a long time are those around abortion/forced adoption/sterilisation where parental and societal concerns were used to pressurise young people into procedures they were not consenting to. "CAPACITY OF MINORS Section 8, of the Family Law Reform Act 1969, commences by providing that “ The consent of a minor who has attained the age of sixteen years to any surgical, medical or dental treatment which, in the absence of consent, would constitute a trespass to his person, shall be as effective as it would be if he were of full age; and where a minor has by virtue of this section given an effective consent to any treatment it shall not be necessary to obtain any consent for it from his parent or guardian.” The section goes on to provide that the expression “‘surgical, medical or dental treatment,’ includes any procedure undertaken for the purpose of diagnosis,” and that the section applies “ to any procedure (including, in particular, the administration of an anaesthetic) which is ancillary to any treatment as it applies to that treatment.” Even if the term ‘‘ trespass to the person ” is taken to refer only to the tort of trespass to the person, the section will have some application to the criminal law. Medical treatment which, in the absence of consent, would constitute the tort of trespass to the person, will normally also come within the purview of one or more offences against the person. see this link for the article www.onlinelibrary.wiley.com/doi/pdf/10.1111/j.1468-2230.1973.tb01373.x The Mental Health Act of 1983 also set out that even those patients who were under section for treatment of their mental health could retain choices around what physical health procedures they underwent so I certainly had some memorable patients who had refused physical procedures even with potentially severe consequences to themselves....so there was an acceptance that people have the right to refuse procedures even if it could be argued that the procedure was in their best interests. Many things around informed consent have changed...at 1 point a person with anorexia could be "allowed" to die as it wasn't deemed appropriate to force feed as that was their "choice"...now we know that feeding a person is both necessary and medically appropriate as a person at this late stage of illness is unable to make informed choices around eating. In the 90's we had regular training about the lines that could be crossed that might lead to a health professional being prosecuted, eg. around covert medication, coercion etc which is why I'm still not clear what grounds a parent could have to force a treatment on their adult child - unless there were very particular issues around mental health /learning disability.... so I can understand how confused you are. I'm glad you are getting support, sending hugs.

Given that your mother coerced /threatend you to attend and to sign the consent, and there were notes about you being distressed and not wanting the procedure, it sounds like the health care professionals acted wrongly in proceeding. If they had suspicion you were not acting under your free will, or that you were unsure about consenting/had concerns about the procedure, they should have taken time to clarify all of this so they were certain of informed consent.
I guess given your mother's actions at the time is not surprising that she still feels she was justified, perhaps manipulative of HCP's too, given that seems to be her method. I don't imaging she would ever admit wrongness of her actions, and it is very painful to hear that you were treated in this way.
If this situation were to arise today, I'd hope our legislation would protect the young person. I believe that ACT is supposed to be a effective form of therapy for people who have had traumatic situations like this occur in the past.

I told them on multiple occasions, they were fully aware and chose to not intervene. I feel let down.

The gp knew at the very very beginning, the hospital counsellor knew, documented it and did nothing on more than one occasion, more than one nurse, a registrar and a consultant. They all just documented it and carried on.

Im glad there are things in place now and people are better protected. This thread has at least helped me as now I know there wasn’t any kind of capacity test in 2000 I was starting to think I’d had one done without my knowledge somehow at one of my appointments? I knew I hadn’t but couldn’t make sense of how the events unfolded with my mother being in total control

I think the worst part of all in the notes is how they documented I ‘clearly stated’ I didn’t want the procedure and on the next page notes about to send me home to reconsider and about rebooking for the next week

My mother actually threatened me in front of a dr that I had to stay and have the procedure done (second trimester abortion) and said if I didn’t the first week she would not come with me the second week and I’d be alone.

I took that as a good thing so went home thinking I’d ended the whole ordeal not realising she had been just saying that and that she didn’t mean I could have my way . I then had a week of hell. The hospital rebooked it for me ???? They put in my notes on the day i refused for me to reconsider and how they would rebook

So sorry you went through this OP.

Ok this is an area of law I know extremely well. I work in MH and have been performing capacity assessments pre and post MCA since the 90s.

No one has ever been able to give consent on behalf of another adult to abortion in English law. Even if you did not have capacity your mother could not have consented on your behalf and the hospital could not legally override your refusal.

In the rare cases an individual lacks capacity but an abortion may be in their best interests drs will usually apply to the Court of Protection for a declaration that this is compatible with the person's best interests. Before the CoP was created the application would have been to the High Court.

I think your notes should be read as saying you refused at the first appt. The hospital sent you home. Mother thought you would reconsider and rebooked on that basis. At second appointment they presumably thought you were giving a capacitous consent and went ahead with the procedure. If they thought you were refusing and went ahead they committed battery and a very serious one too. They could not have thought they were justified because you lacked capacity.

I am sorry this happened. Depression even if current is very unlikely to affect someone's capacity to make decisions re medical procedures especially involving reproduction.

It sounds like nowhere near enough safeguards were applied in your case to ensure the choice was your own. And that you were placed under excessive pressure by your mother.

I agree with the advice you need to explore this with a trained counselor. It sounds deeply upsetting.

You have already been advised it is too late to take legal action. You can consider if you want to notify the hospital authorities of what happened to you. Writing a letter might be helpful not as complaint but to explain what happened and ask what safeguards are in place to protect women now. A counselor might help you do this.

Yes - I signed the consent form on the day (after threats) but as she said to me on the day - as soon as I had signed that nobody could accuse her of anything

The gp with the initial referral put how I wanted to continue but he wanted me ‘considered’ for termination and then wrote a lot of Info from when I was 14-16 and it was very odd . I later found out my mother had met with him prior to that and had told him what she wanted to happen so when I went with her and said no - he referred me anyway. So a series of errors.

A horrible series of mistakes I suppose is better than something illegal , I just wasn’t sure about capacity assessors but Thankyou for helping clear it up for me

The language of 'considered' for abortion and the references to your earlier depression won't be a reference to your capacity at 18. Under the Abortion Act women cannot elect to have an abortion. They can only have one if two doctors recommend it on physical or mental health grounds. Your GP was saying you should be considered for abortion on the grounds that your MH might deteriorate if you did not receive one. The hospital would need that recommendation as otherwise they could not legally carry out an abortion. However had you refused you refusal should have been respected. It is not and has never been lawful to perform an abortion on a woman without her consent to protect her mental health.

At this distance I can't comment on whether what happened was an accident or not but it sounds upsetting.

If possible I strongly recommend counseling for this. A lot of counselors specialise in post abortion counseling. It can cause very strong feelings of loss and guilt and talking to someone who understands the process and will listen without judgement is really important.

Hi OP, I've not read the full thread but I'm a hospital director and specialise in patient consent. Once 18 nobody can make decisions on your behalf unless they have undertaken a mental capacity assessment and it is clearly documented in your notes - even those decisions have to be double checked with a second Dr and with the patients family/advocate or someone with power of attorney. The only exception to this is if for example you are in a life or death situation (e.g. under anaesthetic on the operating table) and a decision needs to be taken extremely quickly in your best interests. If your between 16-18 its down to the Dr to determine if the patient fully understands the subject to be able to make their own decision. Even under 16, if the child disagrees with the parents wishes the Dr would be best seeking legal advice and getting a court to decide what the best decision is.

Thank you , now I have more facts about capacity assessment I think this was more a case of professionals ignoring coercion , they knew and documented it but chose to allow it. So nothing illegal which is reassuring but probably not very ethical 😞

I think with that original letter from the gp the fact he had stated I wanted the pregnancy but he was still doing a referral really upset me as I hadn’t asked for a referral - I only wanted a referral to antenatal care

I also wa annoyed that he referred me for an abortion I clearly stated I didn’t want- added a whole unnecessary paragraph about behaviour aged 14 at school, and then college and information about my parents separation and how difficult it was for my mother ? Almost as if it was being presented as she would have to look after the baby? And that she wouldn’t be able to cope so this had to happen (but that wouldn’t have been the case it seemed to be the only explanation for the wording and maybe for her power in this situation I wonder if the coercion was overlooked as she was saying it would all fall to her and that she couldn’t cope so they did it for her ?)

Even though the mental.capacity act didn't exist the medical staff should have been listening to you and what you wanted not your mum ,I was A mental health nurse in 2000,so it absolutely had to be adhered,otherwise it would have been abuse of the act
I'm sorry this happened to.you.