Zeki was referred to POhWER for support from an Independent Mental Capacity Advocate with a serious medical treatment decision about having a dental procedure. Zeki has learning disabilities and had been assessed as lacking capacity to make this decision.

Kara, a POhWER Independent Mental Capacity Advocate, met with Zeki at a day centre he attended regularly with his carers. Kara introduced herself to Zeki. Zeki is non-verbal and communicates with sounds and gestures. Kara used a number of communication methods to try to engage Zeki in a conversation but he wasn’t able to respond in any way to questions Kara asked him about his teeth or the dentist. 

Kara then took the non-instructed approach and observed Zeki in a number of situations. She also spoke to his family (who didn’t want to be involved in making this decision), and his regular carers who have supported him for a number of years. Kara wrote a report and gave this to the decision maker.

Kara attended the meeting where professionals discussed dental treatment options, the best way for treatment to take place, and if the treatment should go ahead. 

It was clear from photographs the decision maker shared at the meeting, that many of Zeki’s teeth were missing, damaged, decaying, and stained and had been in poor condition for some time. There were also signs of the gums receding. 

The decision maker explained that it might be necessary to use a general anaesthetic to remove and repair as many of Zeki’s teeth in one go as possible to prevent Zeki having to have lots of separate treatments. 

There were no medical records about Zeki having undergone general anaesthetic before, so any allergies and reactions were unknown. There had been no concerns about Zeki’s behaviours at previous visits to the dentists, so there was no evidence that general anaesthetic was required. It was then discussed if this treatment was necessary, and in Zeki’s best interests, at this time. 

Kara reported that Zeki was not complaining of any pain or discomfort and he is not being prevented from eating. Zeki often smiles widely and does not try to hide his teeth. He is also now allowing his carers to support him to clean his teeth twice a day. Zeki does not object to attending the dentist when carers take him to appointments.

The decision was made that no treatment would be carried out at this stage. This was the least restrictive option, and in Zeki’s best interests at this time. Zeki would continue to receive support from carers to improve his dental hygiene, and attend regular check-ups. All parties are aware of the need to re-refer for advocacy support if circumstances change and treatment is required in the future, when a different decision might be made in his best interests.