Capacity Dispute Between Patient and Family
MMIHardAnswer the question
Capacity Dispute Between Patient and Family
An 82-year-old woman with mild cognitive impairment has decided to refuse a recommended hip replacement after a fall. Her son is furious — he insists she lacks capacity, that "she'd agree if she understood", and demands you proceed against her wishes. How do you handle the conversation with the family while protecting the patient?
What are the four functional elements of capacity, and how do you assess them in this scenario?
Why is "she'd agree if she understood" not a basis for overriding refusal?
How do you keep the son engaged as a future support person rather than alienating him?
Speak it out loud and we'll type it for you (free), or type your own notes — then mark yourself below.
- SPIKES for breaking bad news: Setting, Perception, Invitation, Knowledge, Empathy, Strategy.
- Listen → empathise → check understanding → agree a plan together. Calm voice, no jargon.
What strong answers doReveal the benchmark
Hidden so they don't bias your answer. Score yourself first, then reveal them to compare.
- Capacity has four functional elements (understand, retain, weigh, communicate), is decision-specific, and is not removed by mild cognitive impairment; assess and document each element, and if capacity is present the refusal stands.
- "She'd agree if she understood" inverts the test: the question is whether she understands enough to decide, not whether she would reach her son's preferred outcome. An unwise choice is not evidence of incapacity.
- Keep the son engaged: acknowledge his fear, ask what worries him, explain (with her consent) what she has weighed, and give him a practical role, while never re-assessing capacity just because the family dislikes the answer.
Mark yourself
Score each skill against the rubric, then add a line of evidence. Scale:
Ethics
0/3Protects right to make unwise decisions, distinguishes functional capacity from outcome agreement
Communication
0/3Keeps the family engaged while protecting the patient
Healthcare Knowledge
0/3Accurate on the four functional elements of capacity
Insight
0/3Recognises that today's family relationship is tomorrow's safety net