During a regular visit to a local care home, you are asked to administer the flu vaccine to an elderly resident. However, her daughter, who is visiting at the time, says her mother has dementia and questions your right to administer the vaccine without her authority. What should you do?
Expert advice
You first need to consider whether the patient has capacity to consent to the vaccine herself. The first principle of the Mental Capacity Act 2005 is that you must assume a patient has the capacity to make a decision unless it is established otherwise. This may vary according to the complexity of the decision and may fluctuate. If your patient lacks capacity to consent to having the vaccine, she will be unable to:
- Understand the information relevant to the decision (including information about the reasonably foreseeable consequences of deciding one way or another, or failing to make a decision).
- Retain that information.
- Use or weigh that information as part of the process of making the decision, or
- Communicate his decision (whether by talking, using sign language or any other means).
If the patient has capacity and indicated her consent then you can proceed although it's always a good idea to record the consent process in your notes.
If, on the other hand, the patient lacks capacity to consent, you need to find out if there is someone with lasting power of attorney or a court-appointed deputy with the authority to make decisions on her behalf. This may well be her daughter and if so, you require the daughter's authority to administer the vaccine, assuming that this is in the best interests of the patient.
If no one has been appointed to act on the patient's behalf, you need to consider whether the vaccination is in her best interest. In deciding this you should bear in mind anything you know about the patient's previously expressed views and consult anyone who may give you an insight into their wishes.
Again, as the daughter is present, it makes sense to ask her about her mother's views. If she raises a strong objection to her mother receiving the vaccine this may well influence your decision and you may feel it makes sense not to administer it on this occasion. You may be able to discuss this with the patient's daughter and allay any concerns she may have. It's a good idea to note what has happened in the patient's records and explain the situation to the care home staff so that no one else is asked to administer the vaccine.
Dr Louise Dale, is a former GP based in the Midland and a MDU medico-legal adviser
