Part of a series of Mental Capacity Act training videos commissioned by NHS England.

Case Study Six. Issie. A young female student with cerebral palsy who has collapsed and been taken to hospital late at night. She is unconscious. The dilemma for the professionals involved is who should they consult when there is no immediate next of kin? Potentially if Isabella needs serious medical treatment does this fall within the doctors’ duty of care regardless of the MCA? Should issues such as DNACPR be considered?

Isabella is 24 years old (known as Issie), she is a mature student studying for a B.Sc. in Psychology at university. She lives and studies away from home. Issie has cerebral palsy (ataxic), epilepsy and increasing issues with her swallowing, which has resulted in recent episodes of aspiration pneumonia. She is now on thickened fluids. She uses a wheelchair and relies on the carers for a lot of her personal care needs. She lives in specially adapted accommodation at the university and has a team of personal assistants who support her 24 hours per day. Her only relative is her mother who lives abroad and has alcohol problems. She has all but given up on Isabella.

Late on Saturday evening under the care of a temporary support worker, Isabella collapsed and was admitted to hospital. She is currently unconscious as a result of her choking and an epileptic seizure.

Current decision making issues for the professionals involved

Issie has had treatment at this hospital before so there is some medical information on file. However, the Junior Doctor now needs to establish further background information to assist her in planning the next few hours of her care. Issie’s health situation is not yet stable. She is unconscious and therefore she lacks capacity. There appears to be an incomplete picture as to what actually happened before admission. The Junior Doctor, Dr Simmons, is discussing Issie’s situation with her personal assistant, to establish relevant information to what would be in her best interests, including whether she has made any advance decisions to refuse medical treatment.

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