Patricia* is an elderly lady diagnosed with Dementia and learning difficulties. She also suffers with Sigmoid Volvulus, a condition causing abdominal pain, constipation and expanding and swelling of the stomach. Urgent surgical treatment (a colostomy) was required to provide an alternative channel for bodily functions, this would require a stoma bag being fitted which is external to the body.

Patricia underwent a Capacity Assessment around the decision and was deemed to lack capacity. Consultants were concerned that Patricia may be confused with having a bag attached to her body and could pull at the tubes causing internal bleeding and infection.

The consultant who is the decision maker made a referral to us to provide an Independent Mental Capacity Advocate (IMCA) to support Patricia as she had no appropriate family or friends to consult.

How we helped

The IMCA visited Patricia in an attempt to ascertain her views and wishes around this decision. Patricia had little or no speech and therefore the IMCA had to look for other external clues such as behaviours that would suggest Patricia was in pain.

The IMCA consulted with staff who confirmed that when Patricia was in pain the behaviours displayed would be pacing aimlessly, holding her abdomen and moaning. The IMCA also consulted with the decision maker and accessed relevant records in an attempt to gain as much information as possible.

A Best Interest Meeting was suggested where all parties involved could discuss the benefits and burdens of the proposed treatment. The outcome of the meeting was to fit a dummy stoma bag to see how Patricia would respond under observation. The trial went well and the procedure went ahead.


Improved health and emotional wellbeing - Patricia benefitted from an improved quality of life with freedom from pain. Her risk of infections were also minimised.
Freedom from discrimination - Best interest decisions were audited by the IMCA. The IMCA reported that the decision maker had followed the Mental Capacity Act by assessing capacity around this specific decision and all least restrictive options were considered. All parties involved in Patricia’s care took all practicable steps to involve her in the decision making process.

*Names have been changed to protect the identity of the people we support