Case: Consent and Capacity - Advanced Case

A 23 year old male is brought in to the emergency department boarded and collared after a high-speed motor vehicle collision. He was complaining to paramedics of neck and back pain. On arrival he is pulling at the collar and trying to unbuckle the straps. You note a strong smell of alcohol. You explain why he needs to be immobilized – that he may have a serious neck injury and he could suffer a significant neurological injury if he does not keep his neck immobilized - and that you want to do some x-rays. He tells you to “@#$% off” and says you better get him out of this collar right now or he is going to “sue your $@# off”

1) Do you have his consent to proceed with imaging? Would you honour this refusal of care? Why or why not?

2) How would you assess this patient's decision-making capacity?

3) How would your capacity assessment affect your subsequent actions in this case?