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kris

Personality disorder and Capacity- Dilemma

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Our team recently faced an intriguing clinical management issue , where an in-patient with definite diagnosis of Emotionally unstable borderline PD with possible PTSD who after a professionals' meeting allegedly took an impulsive overdose of 20 tablets of a calcium channel blocker (prescribed).

Following the suspected overdose, she refused to co-operate with medical intervention including basic physical observations. :-X :-X

Questions are:

1. Does she have capacity to make that decision? (Despite we knowing that it was an impulsive act consistent with her diagnosis and to make matters worse she was not co-operating with capacity assessment as that was one option)

2. Can she be treated under common law against her wish?

I am curious to know what people think and how they would manage this situation.

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I believe you've answered it yourself - she does not have capacity as it requires her to communicate certain wishes etc etc etc. I will treat her under common law and later be sued for saving her life.

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just curious about the outcome?

did she change her attitude and co-operate.......

did u have to transfer to medicine............

:-?

how did u manage...

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Our team recently faced an intriguing clinical management issue , where an in-patient with definite diagnosis of Emotionally unstable borderline PD with possible PTSD who after a professionals' meeting allegedly took an impulsive overdose of 20 tablets of a calcium channel blocker (prescribed).

Following the suspected overdose, she refused to co-operate with medical intervention including basic physical observations. :-X :-X

Questions are:

1. Does she have capacity to make that decision? (Despite we knowing that it was an impulsive act consistent with her diagnosis and to make matters worse she was not co-operating with capacity assessment as that was one option)

2. Can she be treated under common law against her wish?

I am curious to know what people think and how they would manage this situation.

Please see the other thread on PD and Capacity. You or someone responsible for her care (consultant, RMclinician) will have to determine her capacity to give consent on the 'basic physical ' stuff you think she needs. You cant 'assume' it even if she has a PD. You have to ascertain the basic Capacity elementes. After that you have to determine whther she will fall under the Mental Capacity Act or not. If she does you can only give the care for which you have determined the capacity ( the basic stuff like monitoring and treating for complications of the overdose). if you feel she has a mental disorder and is a risk to herself or others, it will go under the MHA. You cant quote 'common law' in almost all scenarios, now that there is the MCA. And I would think of involving the patients nearest relative and the trust lawyers in assessing capacity and using the MCA. BTW a similar station was piloted in a GMC pilto exam to assess a clinician's clinical skills (specifically psychiatry in this case) who is undergoing Fitness to Practice asessment which will form part of the overall assessment. So physicians will be asked to assess Capacity and consider MCA everytime there is such a case. It is a basic skill.

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