? Capacity, declining surgery

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


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


  • 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 


  • 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


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