Terry is a 50 to 60 year old Black British gentleman residing long-term on a mental health inpatient rehabilitation unit under Section of the Mental Health Act. The IMCA referral was regarding proposed serious medical treatment following a recent diagnosis of lung cancer.

A scan (CT or PET) was needed to establish the extent of the cancer and the specific treatment options. Terry was refusing to undergo this procedure but was deemed to lack capacity to make that decision himself.

Prior to visiting, the IMCA had email correspondence and telephone conversations with the consultant psychiatrist who knew Terry well. The IMCA also obtained further information regarding the proposed treatment options and potential consequences so these could be discussed with Terry during the visit.

Terry was initially deemed as having capacity regarding his medical treatment, but when re-assessed some months later was deemed to no longer have capacity to make a fully informed decision. As Terry had no family or friends who could be consulted, an IMCA referral was made to uphold Terry’s right to independent representation.

The IMCA arranged a visit with the unit and preparations were made in advance for the IMCA to access records and meet Terry in private.

Terry made it very clear to the IMCA that he did not believe that he had lung cancer and was adamant that he therefore did not need or want any treatment related to cancer (he was compliant with his mental health treatment).

Several attempts had been made for Terry to undergo a scan, but these had all failed, some at the very last minute when Terry was already at the hospital and the scan had commenced. Terry recalled these appointments and was therefore able to discuss this with the IMCA when providing his views.  

Following the IMCA visit, a best interest meeting was held; the hospital consultant, who was the overall decision maker, was in attendance. All treatment options and potential outcomes were discussed including the pros and cons of each, and a decision was made that it would be in Terry’s best interests not to proceed with the proposed treatment but rather to take a ‘watch and wait’ approach to his illness and if necessary, treat with palliative approach once symptoms occur.

It was however agreed that Terry would be offered an appointment for a scan once last time and that professionals would continue to intermittently attempt to discuss the treatment with Terry in case his views changed, or he regains capacity.

The IMCA was aware before meeting Terry that he had not been willing to engage with anyone regarding anything to do with his diagnosis of cancer. Having been made aware of this, the IMCA ensured to approach the meeting particularly tactfully and as a result Terry did engage to a certain extent in a discussion regarding the proposed treatment.  Knowing the potential difficulty beforehand allowed the IMCA to prepare better for the client meeting.

The decision made at the best interest meeting to not attempt any further scans if Terry continued to refuse was in line with his stated wishes not to have any treatment related to his cancer. IMCA involvement with Terry ensured his wishes and feelings were kept at the heart of the decision making process, and that although he did lack capacity to make this decision himself, his beliefs meant that going ahead with the procedure at this time may have had more burdens to Terry than benefits.