Case 72: She is refusing treatment. Her decision is wrong. She must be mentally ill

This chapter presents a case of a 75-year-old woman who needs an operation to remove a breast lump. The lump is malignant but is isolated, and there is no evidence of any local or distant spread. Capacity should be reviewed on a regular basis. Temporary impairment may improve. A person with a progressive illness such as dementia may lose capacity to make decisions. Some patients will have previously recorded a decision about what they would decide if particular circumstances arise. The Mental Capacity Act is clear that anyone who has the care of a person who lacks capacity, and wilfully neglects or ill-treats that person, is guilty of an offence. In this scenario the patient cannot be treated against her wishes unless it can be demonstrated that she lacks capacity to decide whether or not to have the treatment, and that the treatment is both necessary and in her best interests.