Best interest meeting for elderly mother ....help.

[Tolkienista]

My mother is 96 , lives in a care home.
Her mobility is in decline and she's in cognitive decline too.
Has she got dementia? It's hard to say she is often muddled and confused.

Anyway to the issue.....she had vaginal bleeding, a ring pessary was taken out which immediately stopped the bleeding but she was referred for a scan which picked up something in her endometrial cavity. The gynaecologist said "its a mass ,could be a polyp, small chance it could be cancer."
He wants to refer her for a Hysteroscopy which would need to be done under LA.
He said that we as a family would need to discuss it, which we did and we have decided it's too much for a 96 year old woman to go through, she's not in any pain and there's no more bleeding.
We have power of attorney.

This morning I received a phone call from a gynae oncology nurse about this procedure, I told her of our decision. She asked about power of attorney & said they'd have to set up a "best interest meeting" on teams.
Is this straightforward or am I right in feeling concerned?
I did explain my mother's cognitive decline, and hearing problems too.

Desperate for advice, going forward.
A lot of this is falling on me and I'm struggling with it to be honest.

That is very helpful, thank you.

Thank you for your very helpful comment

I think the nurse is a bit confused.

A best interests meeting is only needed if the person does not have mental capacity for the decision. So the only reason to have one at all is that someone thinks she doesn't have capacity to refuse treatment.

If she doesn't gave mental capacity for this decision (which it certainly seems like she doesnt), then the holders of Lasting Power of Attorney can make the decision to refuse treatment on her behalf - which you've already very sensibly done.

Where someone doesn't have capacity for a medical decision, and nobody has lasting power of attorney or deputyship for them, then the best interests decision rests with the consultant. They should talk to family/trusted people to make that decision, to try to understand what their wishes would have been if they could decide for themselves.

There is no need for you (or, frankly, all the medical staff) to spend precious time and energy on this meeting because the decision rests with you and you have told then what it is. I hope that's what the consultant will say when they read the notes about what the nurse said to you.

The idea that a 96 year old woman should have this treatment, wasting a second of her time and energy going to hospital for it, is absolutely insane.

If the gynae was talking to you in the way you describe to say that you should make the decision for her, then I would be pretty sure that they've already noted that she doesn't have capacity for the decision.

As others have said, the first thing that needs to be done is a capacity assessment to establish whether or not your dm has mental capacity to make this decision herself.

If she does then she makes the decisions - even if others think they are unwise.

If not then a best interest meeting should be arranged to make a decision in her best interests.

You mention that there is more than one person with POA. Is the decision making jointly or jointly and severally? This will influence who needs to be at the meeting, if there is one.

Just to be clear that the only decision any of us can make is to refuse treatment. The doctors decide whether they are willing to offer the treatment in the first place.

I had this procedure a few years ago. In my case it was actually impossible to do it under LA as my cervix wouldn't dilate sufficiently to get the scope in and the procedure had to be abandoned and I was readmitted another day to have it done under GA. You might like to ask what the likelihood is of this happening in your mother's case if they did go ahead. I presume she would not be fit for GA?
Another good reason not to put her through it in my opinion.

@carpool Thank you for your very pertinent comment. That is very true and something to add to our list of points against the procedure going forward.
At 96, there's no way we would counter her going under GA, absolutely impossible.
The meeting is scheduled for the coming days.

I honestly don't know.
At last week's appointment with the gynaecologist all he said was to discuss it as a family to see what we wanted to do going forward. Then two days later when I received a phone call with the appointment for the Hysteroscopy and said we don't want her to have it, the best interests scenario was raised completely out of the blue.
We will all be there for the video call.

Yes those are my thoughts too.
Pretty much all the conversation last week at her appointment with the gynae went through me.

If you have a valid H&W LPA then you are NOT required to have a BI meeting. You can decline it and show them the LPA paperwork. Best interest meetings are for those without LPA. If there is a valid LPA it is abundantly clear in law that the decision maker is the LPA holder. You have 100% right to make a decision on her behalf. It sounds as though you are very much acting in line with her own wishes which is why one gets an LPA.

I would decline this meeting and say you are happy to furnish them with a copy of the LPA paperwork

@ThePure thank you for your comments.
We're going to go ahead with the meeting because one of the participants is a consultant gynae so we'll be able to ask some questions going forward.
At no point in the call last Tuesday was there any option not to have this meeting.
This is the problem, when you have no idea what your rights are you just go with those arranging it, but as I said it will be a chance to speak again to the consultant.

Make sure you confirm that a capacity assessment has been done and deemed that your dm lacks capacity to make this particular decision otherwise none of the poa’s have any legal right to make this decision on her behalf.

It’s fair enough to have the meeting if you feel it would be useful. A reasonable reason to have it is that the consultant might want to be sure that the LPAs have all the info to make an informed decision. However just be clear that you are the decision maker and whilst you are happy to listen to them the final say will be yours.

It’s also on them to do a capacity assessment it’s not your responsibility. They must be assuming that she does lack capacity because per definition you cannot have a BI meeting about a person who has capacity as it is not required for anyone to act in their best interests.

If the clinical team felt very strongly that you as LPAs were not acting in her BI they can refer you to the Court of Protection but this is very unlikely to happen.

I expect the nurse just felt this was above her pay grade and wanted the consultants involvement. Don’t worry about it. This seems to me to be a very proper use of the LPA to advocate what she would want if she had capacity

@ThePure thank you so much for your really helpful reply, your post is both useful and informative.
The nurse I spoke did not give me the impression that they were going to contradict our decision, so we're not worried going into it.
I'll post afterwards what happens on this forum.