16 July 2014
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.
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?
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.
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
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.
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.
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 …