Demands and Requests for ‘Inappropriate’ or ‘Inadvisable’ Treatments at the End of Life: What do You do at 2 O’clock in the Morning When…?

McCrossan L and Siegmeth R

British Journal of Anaesthesia, 119 (S1): i90–i98 (2017) doi: 10.1093/bja/aex359

Aim of Paper

Explore the professional guidance, legal statute, case law, and ethical frameworks that help to steer us when such challenging situations arise. As we will see, however, the guidance can only ever be just that. Putting it into practice is often much easier said than done.

Methodology

Professional body guidance – GMC and BMA

Case studies

Results

Patient with capacity

  • can refuse treatment
  • cannot demand for treatment
  • but should refer to GMC Good Practice – explain why, explore alternatives, seek 2nd opinion, refer for legal advice

Patient with no capacity

  • best interest under statute law
  • other considerations
    • Sanctity and quality of life
    • Best interest
    • Justice
    • Futility
  • LPA can consent or refuse treatment
  • NOK cannot but should refer to GMC Good Practice if disagreement

Conclusions/Discussion

Not as black and white, if in doubt – seek legal advice

Court cannot tell clinician what to do or state what patient should have

Court can only rule if what is proposed by clinician is lawful or not

Case studies conflicting

Utilise mediation service

Preserve relationship because ultimately it comes back down to patient care

Discussion from Journal Club Meeting

Not aware hospital should and have service for 24 hour legal advice

Importance of good communication skills

Importance of clear explanation to patients and family re:their rights when in comes to consenting/refusing/demanding for treatment

Summary by Dr A Tan. Journal Club 7 June 2018.

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