Dementia and vaccine.

[SireeDubs]

Wondering what people’s thoughts are, and if anyone has had this experience....
FIL has advanced dementia - no speech that makes sense and no ability to understand consent. He is quite mobile and stubborn however! GP has previously certified that he doesn’t have the mental capacity to give informed consent.
Nurse came to his and my MIL’s house to vaccinate at home. He refused to cooperate, not on the basis of not wishing to be vaccinated (as ex military, he had vaccinations all his life), but just because he didn’t want the nurse to roll his sleeve up etc.
MIL and nurse planned another day, and same happened, though he got quite verbally aggressive. Nurse understandably didn’t want to push any further.
Now GP has told my MIL that as the surgery have ‘wasted two doses’ on my FIL, then they won’t be trying again. I understand that it’s difficult, but surely, under the Mental Capacity Act of 2005, a vaccine is in his ‘best interest’ (there’s no LPA in place, sadly).
MIL thinks he should be sedated, and then given the shot; not sure about that, but I know that she’s too afraid to go out with him without the vaccine, and it’s affecting her greatly, as well as my FIL.
Any experiences/opinions out there?
TIA.

That's a tricky one. Can you explain a bit more about why DMIL is afraid to go out with him if he hasn't been vaccinated?

I really feel for your Mother in law and the family. It must be such a worry. Take care

Hi Dua... she’s always been very sociable and since my FIL’s health has deteriorated she takes him everywhere she goes (or will resume going after lockdown and when she’s had her second jab). She’s been told that FIL is extremely high risk, weakened as he is with dementia but also underlying heart and lung conditions. So she feels that life can’t commence in any recognisable way until they’re both vaccinated.

Have a similar situation with my Mum - advanced dementia and she will resist any attempts to interfere with her clothing. her appointment is booked for next week at a centre.

We have have power of attorney for health and care but I'm not sure how the centre will react to loud elderly lady threatening heavens knows what to someone in a mask trying to pull up her sleeve . I don't think they'll push it and frankly I think that's right. This could be a category of people who can't be vaccinated, just as those with some cancers etc and we will have to rely on 'herd immunity' to keep them safe.

It's not ideal, I know.

Oh that's such a dilemma. Would the GP discuss this with you any further? Coin do they offer sedation maybe?

It's not necessarily in his best interests if it distresses him.

If you lack capacity but passively accept the vaccine then it's clearly in your best interests

However if you strenuously object to the point of verbal abuse and require sedation that's a different weigh up isn't it? It may then not be in your best interests to suffer the distress and the risks of sedation for the possible benefit of the vaccine.

Practically how would he be sedated in any case? The effects of oral sedatives in themselves can be quite bad in terms of risk of worse confusion, falls etc. Also the timing of the effects of a sedative pill is variable between people. He might still be awake enough to refuse the jab but then sleep the rest of the afternoon.

I honestly don't think any Dr or nurse would continue trying to vaccinate him in those circumstances. I am afraid I do agree that 2 attempts was a reasonable try.

Some people aren't going to be able to have the vaccine for different reasons and they will be protected by herd immunity in the rest of us. If immunisation rates get up high enough case levels will fall to very low levels and he won't be at high risk going out even if not vaccinated.

He can't consent, there is no LPA and he is seemingly emphatically refusing to undergo the vaccination process.

I'm afraid herd immunity and therefore a few more months shielding may be the most humane and least restrictive option.

Sorry, obviously o hadn't thought through the risks of sedation.

I am think there will be a fair few people in this position. TBH even if there was an H&W LPA it wouldn't change the matter.

Even if the LPA consents for him it doesn't make it practically possible. A Dr can't be made to give a treatment that they do not feel is ethically right and I really don't think any Dr would agree to sedate a dementia sufferer to get the vaccine even if their LPA consented to such a course of action.

Thanks so much for all your inputs. I really appreciate it.
I have ethical issues with using a sedation, but it’s really useful to also consider the points raised by Covoid. Unfortunately, my MIL has clung to the sedation thing as the nurse mentioned it was possible after the last failed attempt.
My MIL is just desperate to get out again, but I suspect it’s not going to be quite that easy. As long as it’s all done in my FIL’s best interests...