Radio: iPM on a patient with capacity having her life-sustaining pacemaker deactivated

27 September 2016

Last year, the Radio 4 programme iPM ran an item about an adult patient with capacity seeking to have her pacemaker deactivated:

“Who can make decisions about a pacemaker once it’s in my body?’ – After a listener got in touch with an ethical dilemma, we explore what the UK law says about switching off pacemakers and other implanted medical devices.”

Last week, the programme updated the story with details of the deactivation and eventual death of the patient.

“The listener who fought for her pacemaker to be turned off and the US doctor who helps to stop his dying patients’ hearts.”

 

 

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Comment: Advance decisions to refuse treatment (ADRT) forms in dementia

16 July 2014
I’ve done a little research on advance decisions to refuse treatment (ADRT) forms in dementia for an upcoming BBC Radio 4 episode of Inside the ethics committee, to be broadcast on 31 July 2014 at 9am.
 
The Alzheimer’s Society have a form and a fact-sheet. Dementia Care also has some information on their website which includes a link to an Age UK factsheet.
 
Personally, I prefer the Compassion in Dying form (plus accompanying guidance notes) to the Alzheimer’s Society form. The main reason for this is that the triggering condition for the refusal (i.e. when the refusal is to become effective) is rather strange in the Alzheimer’s Society form. It’s when ‘the gravity of my condition/suffering is such that treatment seems to be causing distress beyond any possible benefit’. The goal of an ADRT is to refuse treatment which others would or might think is in your best interests (otherwise there’s little point – if everyone agrees the treatment is not in your best interests then it would not be lawful to give it under the Mental Capacity Act 2005). This triggering condition doesn’t seem to me to leave much (if any) scope for this. If the treatment causes distress beyond any possible benefit then it is hard to see how it could be given as it would not be in your best interests. The balancing of burdens against benefits is exactly what the courts (and the Mental Capacity Act Code of Practice) require in order to reach a decision on your best interests.
 
You can contrast this with the triggering conditions (there is a choice) in the Compassion in Dying form, the most relevant one of which is: ‘I suffer serious impairment of the mind or brain with little or no prospect of recovery together with a physical need for life-sustaining treatment/interventions’. Here it is quite possible that different people will have different views on whether life-sustaining treatment is in your best interests as the ADRT will be triggered (in dementia patients) once their condition constitutes a serious impairment and there is little or no prospect of recovery. So the ADRT will have a role to play.
 
Compassion in Dying also have a free phone line you can call to get help in filling out the form; details are provided within the form as well as on their website.
 
NB: Compassion in Dying has a relationship with Dignity in Dying. They are separate organisations but they work out of the same offices.

Radio: When assisted death is legal

19 February 2013

BBC World Service

Episode 1: Tuesday 19 February 2013 at 9.05, 13.05, 16.05, 20.05, Wednesday 20 February at 02.05, Saturday 23 February at 19.05, Sunday 24 February at 13.05, also available via the iPlayer

Episode 2: Wednesday 20 February 2013 at 9.05, 13.05, 16.05, 20.05, Thursday 21 February at 02.05, Sunday 24 February at 22.05, also available via the iPlayer after first broadcast

From the programme’s website: “The debate over assisted suicide and euthanasia is a passionate one. But as the discussions continue to rage around the world, there are a few places where assisted death is already legal. Switzerland, Belgium, Luxembourg, the Netherlands, and Oregon and Washington States in the US all have laws permitting assisted suicide or euthanasia in some form. In this two-part documentary for the BBC World Service, actress and broadcaster Liz Carr goes on a personal journey to all six places to see how it works. As a long-standing campaigner against assisted suicide legislation in the UK, she wants to find out what assisted death means in practice – and whether she’s right to be concerned. In part one, Carr travels to Switzerland, where she visits the rooms where volunteers help people die, and finds out why the Swiss law on assisted suicide goes back to the 19th Century. In Belgium she meets a doctor who admits to performing euthanasia before it was legal; and in Luxembourg, she finds out why the law on assisted suicide nearly caused a constitutional crisis. Carr questions whether it is possible to balance the right of the individual who wants to die with the responsibility of society to protect those who don’t. … In part two, Carr visits the Netherlands, where she meets the group behind the ‘mobile euthanasia units’ which hit the headlines last year, and asks whether a law on voluntary life-ending procedures might open the door to involuntary ones. She also visits Oregon and Washington State in the US, where she finds out who is most likely to use the Death with Dignity law, and hears about the cancer patient whose health-care plan refused to pay for chemotherapy – but offered assisted suicide instead.”

In the first episode, Carr states that in Belgium, only euthanasia (termination of life on request) is lawful, and that assisted suicide is therefore not practised (lawfully). It is correct that in Belgium, the Euthanasia Act 2002 allows only physicians to perform euthanasia (understood in the Netherlands as termination of life on request). Assisted suicide is not explicitly covered, but Belgium’s oversight body, the Federal Control and Evaluation Commission (Commission Féderale de Contrôle et Évaluation or CFCE), accepted early on that cases of assisted suicide fall under the law (Commission fédérale de contrôle et d’évaluation de l’euthanasie, Premier rapport aux chambres legislatives (2002–2003), 2004, pp 13–14). Cases of assisted suicide are now reported to the CFCE and reviewed in the same way as cases of termination of life on request. In 2010-2011, eight such cases were reported (out of a total of 2086 cases) (Commission fédérale de contrôle et d’évaluation de l’euthanasie, Cinquième rapport aux chambres legislatives (2010–2011), 2012, p 17).


Radio: too old to donate?

26 July 2012

BBC Radio 4, 26 July 2012, 21.00-21.45, also available via the iPlayer or as a podcast

From the programme’s website:

Since losing her husband to a terminal illness, and watching his kidneys fail, Pamela has felt a burning desire to try to help someone else escape a similar fate.

A year after his death, she writes to her local hospital to ask if she can become an ‘altruistic’ donor, and donate one of her kidneys to a stranger. To her horror, she receives a letter back saying that she is ‘too old’. Undeterred, she approaches a transplant surgeon at another hospital, and he agrees to see her.

To the surgeon, Pamela appears fit and extremely determined. But for a potential donor, she’s also rather unusual – she’s eighty two years old.

Should Pamela be allowed to donate? What are the risks to her – both of the operation itself, and of being left with only one kidney? And, if the team allow her to donate, who should receive such an elderly organ?


Radio: restraining patients in intensive care

16 July 2012

Inside the Ethics Committee

BBC Radio 4, Thursday 19 July 2012, 09.00-09.45, repeated 21.00-21.45, available via the iPlayer or as a podcast

From the programme’s website:

Monty has double pneumonia and is in intensive care. A ventilator is breathing for him and he’s sedated so that he can tolerate a breathing tube in his throat. Given the risks associated with being intubated in this way, the team are keen to get him off the ventilator as soon as possible, so that he can start breathing for himself.

After several days of antibiotics, Monty improves. So they stop the sedation, wake him up, and remove the breathing tube. The plan is for Monty to wear a mask to support his breathing until he is strong enough to breathe for himself.

But Monty is autistic, and as soon as the mask is placed on his face, he pushes it away. The nurses put it back on, but again he bats it off. The nurses persist, but Monty struggles and lashes out at them. Exhausted, he starts going blue. Fearing for Monty’s life, the team re-sedate him and put him back on the ventilator.

As his life hangs in the balance, what lengths should the medical team go to to get Monty to accept the life-saving treatment he is struggling against? Should they physically restrain him?

Joan Bakewell chairs the discussion between medical and ethical experts.


Radio: two-part documentary on truth-telling in cases of negligence and misadventure

20 February 2012

Doctor – Tell Me The Truth

BBC Radio 4, Monday 20 and 27 February 2012, 20.00-20.30. I expect episode 1 will be available via the iPlayer shortly

Part 1:

Each year between 45,000 and 98,000 Americans die because of the treatment they receive in hospital. In Doctor, Tell Me The Truth, Professor James Reason discovers how encouraging doctors to admit their mistakes has improved patient safety. He hears from Rick Boothman and Darrell Campbell at the University of Michigan, the creators of a programme where doctors have to be open about their errors. They describe the previous ‘deny-and-defend’ attitude in which the hospital would stonewall any complaints made against them and contrast this with the present system in which investigations into errors can be started even before the patient comes round from their anaesthetic. We hear moving stories about face-to-face apologies from patients, doctors and lawyers.

Part 2:

In the second part of Doctor Tell Me The Truth Prof Reason asks whether the University of Michigan programme could work in the NHS. Peter Walsh from Action Against Medical Accidents tells him of cases where doctors have been prevented from admitting their mistakes at the insistence of their managers. He introduces us to ‘Robbie’s Law’, named after a boy who died as a result of medical malpractice, a piece of proposed legislation now being examined in the House of Lords which would require all NHS hospitals to adopt an open disclosure policy. Academics David Studdert and Alan Kalachian ask whether such a policy is legally enforceable or even desirable. Sir Liam Donaldson, a former Chief Medical Officer, tells us of his attempts to promote openness in the NHS and we hear from Robbie Powell’s father who tells us that his twenty year legal battle could have been avoided if the doctors had only admitted their mistakes and apologised.


Radio: Alexander McCall Smith on Medical Law and Ethics

6 February 2012

One to One
BBC Radio 4
Tuesday 7th February 2012, 09.30-09.45
Available after broadcast via the iPlayer

From the programme’s website: “Bridget Kendall talks to those who are well known in one field but are experts in another. She talks to the prolific author Alexander McCall Smith, best known for The No 1 Ladies Detective Agency who’s also an Emeritus Professor of Medical Law . They discuss how his academic interest in the legal and philosophical aspects of responsibility feed into his work as a novelist.”

I’m not sure how much Medical (as opposed to Criminal) Law there will be …