Darren – scenario for training

Mental Capacity Act workbook

Commissioned by, and hosted here on the MCA Directory on behalf of, the members of the NHS Eastern Region Safeguarding Adult Forum facilitated by Eleanor Sherwen & Sarah Robinson.

View here online or order a DVD or workbook

Learning outcomes

For participants to recognise that

Darren’s story

Darren, aged 22, has a mild to moderate learning disability. Darren has lived with his parents since birth and they are now in their early seventies. His mother is the carer for his father who has Parkinson's disease. Darren communicates with words and gestures, and he is an excellent "mimic" of other people's language patterns. He doesn't necessarily understand what he is saying all the time. He attends a local day centre 3 days per week. Darren doesn't like people touching his face or head. He doesn't like needles to the point where this is now a phobia. Darren will scream if he sees pictures of needles on the TV. His dental hygiene is poor. He has recently seen a community based dentist who has recommended treatment at the regional dental unit at the local hospital.

Current decision making issues for the professionals involved

The decision for the professionals, the dental surgeon and his community learning disability nurse involved is whether the urgency of the treatment is such that it needs to be carried out soon or could Darren have a desensitisation programme which would support him through the dental treatment? The professionals need to consider whether it is appropriate to assess Darren’s mental capacity in relation to the decision they require him to make.

The ethical decision

The ethical issue for the professionals involved (the surgeon and the community nurse), is whether Darren’s learning disability is such that he cannot make a decision about his treatment and therefore cannot consent to the proposed dental extractions. If it is decided that he lacks capacity, how far should any restraints (e.g. physical or sedative medication) be used to allow the treatment to be carried out? At what point do these become a potential deprivation of his liberty?