Part 2

Dr Praed encourages Mr Green to involve his mother. While Mr Green says he understands the consequences, he assures Dr Praed that he will take steps to manage the situation on his own.

Dr Praed receives a call from Mrs Green saying she now knows where her son is staying, that he is regularly binge drinking, and that she doubts he is monitoring his diabetes: she is increasingly worried that his friends are having a bad influence on him.

A week later, Mr Green arrives for an appointment with Dr Praed looking dishevelled, smelling of alcohol and upset because his friends have more than once failed to return his music player, mobile phone and money they have ‘borrowed’ from him. He has not been monitoring his diabetes, and when Dr Praed does a finger prick test it shows his blood sugar level to be high.

Dr Praed strongly suggests that Mr Green now needs to let his mother help him and highlights his concerns about his new friends, suggesting that he should involve the police because it sounds like they have been stealing from him. But Mr Green is confused about whether he wants his mother involved and when the police are mentioned, he becomes afraid that his friend Paul will get into trouble. Mr Green describes Paul to Dr Praed, who realises that Paul is another of his patients, who he knows to be a drug addict with a long criminal record for theft.

Dr Praed needs to make a judgement about whether Mr Green currently has the capacity to make a decision about whether his mother or anyone else should be involved in his care. Dr Praed should give Mr Green the time and support he needs to maximise his ability to make decisions for himself.⁴

Dr Praed should make every effort to explain to Mr Green the importance of involving others in his care. If Mr Green is adamant that he does not want his mother involved, another appropriate person from adult social services might be able to assist (paragraph 61).

If he considers that Mr Green lacks the capacity to make the decision, and it is essential in his best interests (either because of the risks to his health from neglect of his diabetes or because he is at risk of abuse), Dr Praed should disclose relevant information to an appropriate person or authority (paragraphs 61 and 63).

It appears that Mr Green may be a victim of crime and vulnerable to further abuse. Additionally, Paul and Mr Green’s other friends may be a risk to other vulnerable people, so that disclosure of information about the reported theft might also be justified in the wider public interest (paragraphs 53 to 55).

It may be appropriate for doctors to encourage patients to consent to disclosures they consider necessary for their protection, and to warn them of the risks of refusing to consent; but competent adults’ refusals to consent should usually be respected, even if that leaves them at risk of harm (paragraph 51). If Dr Praed judges that Mr Green has capacity to make the decision, he should still consider whether his learning disability makes him unusually vulnerable to abuse or neglect. The interaction between difficult assessments of capacity, best interests decisions and public interest disclosures can make these types of situations particularly difficult to resolve.