Severe learning disability

A 32-year-old woman with severe learning disability is diagnosed with breast cancer. She does not understand her diagnosis or treatment options. Her next of kin insists on no treatment.

What is the most appropriate course of action?

A) Follow the family’s wishes
B) Proceed with treatment in her best interests
C) Seek a court order before making any decision
D) Ask social services to take over her care
E) Discharge her without treatment

Correct Answer:

B) Proceed with treatment in her best interests

Explanation:

• Lack of capacity → Decision made in "best interests" under the Mental Capacity Act
• Next of kin cannot refuse treatment unless legally appointed (power of attorney or court-appointed guardian)
• Doctors must act in the patient's best interests after multidisciplinary discussion.
• A) Follow the family’s wishes → Incorrect. No legal basis unless they hold power of attorney.
• C) Seek a court order → Incorrect. Only needed for complex cases, not routine care.
• D) Ask social services to take over her care → Incorrect. Social services can be involved but not necessary to delay urgent treatment.
• E) Discharge her without treatment → Incorrect. Would be medical negligence.

Key Tips for PLAB 1:

✅ If a patient lacks capacity, decisions must be in their "best interests"
✅ Next of kin cannot make decisions unless legally authorised
✅ Court involvement is only needed in complex cases