An 85-year-old female with dementia has fallen and broken her hip. She requires surgery, however, due to her dementia she is struggling to understand what the doctor is telling her, and is asking to go home.

Which of the following describes the next step that the doctor should take to maintain as much of this patient's autonomy as possible?

Options:
explanation: This is not the appropriate choice. The patient has not fully understood her situation, and whilst allowing her to go home is respecting her current wishes, this decision may have been taken due to her cognitive dysfunction. Going home is also against the best interest of this patient.

Therefore, the doctor should take measures to make sure the patient understands what has happened to her before he can fully listen to the patient's wishes. Her wish to go home may change once she has fully understood what has happened.

If it is concluded that she does fully understand what is happening, and she still wishes to go home, at that point, it would be much more appropriate to allow her to return home.
name: Allow her to go home as the patient is asking for this
label: b
answer: no
explanation: This would not be the best option to maintain the patient's autonomy. This would be overriding this patient's autonomy even if it were in the patient's best interests.

The best approach to this situation would be to try another method to help this patient understand their condition - just because the patient has not understood the doctor the first time, does not mean they will not understand if it is explained differently. People without dementia will sometimes need things to be repeated or explained in a way that works for them - deciding on their behalf is very inappropriate in this case.
name: Make a decision based on the patient's best interests
label: e
answer: no
explanation: This is the correct choice - it is clear that this patient cannot yet consent to surgery, since she has not understood what exactly has happened and what could help her.

The doctor should therefore attempt to enhance her autonomy, explaining the procedure in different ways, and involving other healthcare professionals if needed, to see whether this patient can gain the capacity to consent to her procedure.
name: Explain the patient's situation to her in a different way
label: a
answer: yes
explanation: Although the patient's family members are likely to make choices that are in the best interests of this patient - we have not yet concluded that the patient cannot decide for themselves.

Although she does have dementia and does not currently understand what has happened to her, this can change - especially if trained healthcare professionals are consulted to try and enhance her capacity to consent to procedures. This should be attempted first before consulting the patient's family for consent.
name: Ask her daughter to decide for her
label: c
answer: no
explanation: Her carer is likely to be a trained healthcare professional who has been in these situations before. However, we have not yet concluded that this patient cannot consent herself.

The doctor should first try other methods to help this patient understand her condition before allowing her decisions to be made by other people, stripping the patient of her autonomy.
name: Ask her carer to consent to the procedure for her
label: d
answer: no

Correct answer: a