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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