Cancellation on day of surgery: 19-year-old for wisdom tooth extraction

Background

• Ex-premature baby; 25 weeks
• Mild developmental delay
• Autism

Issues:

• Attended hospital on day of surgery with her father but declining to come to theatre and declining premedication
• Anaesthetist reviewed patient in day stay, stated has had previous traumatic experiences in theatre as a child where she felt she was having medical procedures against her wishes.
• Patient stated she doesn’t have any dental pain and doesn’t need or want to have teeth extracted
• Father had signed consent form but is not official enduring guardian
• Procedure was cancelled in accordance with the patient’s wishes 

Discussion

• Formal assessment of capacity is required in this case. 
• Consensus was that the patients reasoning was sound, and cancellation of the procedure was the correct course of action
• Social work contacted and will attempt to facilitate capacity assessment and ascertain if there is a requirement for an enduring guardian
• Social work will attempt to source NDIS funding for psychological support
• Grey area in adults – no psychological or social support for those with PTSD to mitigate stressors of attending hospital/OT as there are for children.
• Significantly, agreement that even if patient doesn’t have legal capacity, it is very difficult to carry out minor (non-life or limb-threatening procedures) if they are not willing.
• Patient advocacy processes should be clearly laid out in these cases

Plan:

• Await formal assessment of capacity
• Face to face review of patient preoperatively