Capacity Dispute Between Patient and Family

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• Capacity has four functional elements: understand the information relevant to the decision; retain it long enough to make the decision; weigh the information as part of the process; communicate the decision. Capacity is decision-specific — she may have capacity for the surgery decision and not for, say, her financial affairs. Mild cognitive impairment does not itself remove capacity; the assessment is functional. Document each element. If you assess capacity present, refusal stands.
• "She'd agree if she understood" inverts the principle. The standard is whether she understands sufficiently to make this decision, not whether she would agree with her son's preferred outcome if she understood. A capacitous patient is entitled to make decisions her son or her doctor would not make. This is sometimes called the "right to make unwise decisions" and is central to autonomy — without it, autonomy is hollow.
• On the conversation with the son: separate "I disagree with mum's decision" (legitimate) from "mum lacks capacity" (a clinical determination). Acknowledge his concern as care for his mother, explain how capacity is assessed, explain that the assessment has been done, name what you can offer (involve the son in future planning, organise additional pain management, provide support equipment, plan reviews so the decision can be revisited if she changes her mind, second opinion if he wants one). The relationship matters because she will need support; alienating him today reduces her safety tomorrow.