Complex capacity issue

20-year-old lady for Removal of wisdom teeth

Previous cancellation on day of surgery as declining OT


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


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


  • Formal assessment of capacity:
    • NSW health special disability referral team pathway
    • Temporary guardianship order granted. 
    • Lengthy process
  • Father struggling with this issue and prefers not to become guardian in this instance
  • No psychological or social support for those with PTSD to mitigate stressors of attending hospital/OT as there are for children.
  • Consensus that even if patient doesn’t have legal capacity, it will be very difficult to carry out minor (non-life or limb-threatening procedures) if patient not willing.
  • Premedication unlikely to improve situation as previously declined


  • Consider pre-hospital premedication
  • Preoperative psychology input
  • Liaise with procedural anaesthetist