8 November 2004
Withholding treatment: a patient’s right to decide
Recent high profile cases have highlighted problems and issues surrounding the withdrawal or withholding of treatment for patients with severe mental and physical incapacity. Experts from many specialties will discuss boundaries of care, the dilemma of whose ‘best interest’ doctors have in mind when administering treatment and the complex decision-making process between patient and doctor at Withholding Treatment, a conference organised by Royal Society of Medicine and the Disability Rights Commission on Wednesday 10 November.
Reaching a decision in mental incapacity
Dr Keith Andrews, Institute of Complex Neuro-disability
Dr Andrews’s presentation will focus on the Mental
Capacity Bill currently in the committee stage in Parliament
and the day-to-day clinical implications. Dr Andrews
says, 'There are two important aspects of the bill. The
first is the ability to assess whether a patient lacks
the capacity to make a decision about their care. The
second is to determine whether treatment is in the patient's
best interest. The new Mental Capacity Bill stipulates
it must be assumed that a patient has the capacity to
make a decision unless after practical steps have been
made it is determined they are unable to make a decision.
Also, mental capacity is decision-specific. In other
words a patient may have capacity to make a decision
about the music they want tom listen to but not for an
operation - capacity relates to the ability to make the
specific decision not to an overall assumption of lack
of capacity.' With regards to making a judgment about
a patient's best interest, he adds, 'People have different
ideas of what they would regard as an appropriate quality
of life for themselves. We must try to understand the
individual you are dealing with, taking into consideration
personal beliefs, culture, religion and values.'
It’s my life – it’s my decision
Dr Jane Campbell MBE, Chair of the Social Care Institute
for Excellence & Disability Rights Commissioner
Dr Campbell will talk about the delicate relationship
between doctor and patient in determining appropriate
treatment and emphasises the importance of an equilibrium
of understanding and respect. ‘Decisions must be
made with the patient’s best interest in mind,
which is also the doctor’s best interest. We have
to take a more holistic view and increase patient power
over their own medical treatment. Doctors want to do
this, but they need training and people need to know
that these lives are worth living and cannot be judged
strictly through a medical diagnosis. Medicine is not
an exact science but with better communication, more
informed decisions will be made.’
The Mental Capacity Bill in practice
Mr Laurence Oates, Official Solicitor to the Supreme
Court & Public
Trustee
Mr Oates’s presentation will focus on the Mental
Capacity Bill and its probable effects on the doctor/patient
relationship. He says, ‘The new Bill will initiate
evolutionary rather than revolutionary change. It largely
clarifies and reinforces principles and practices already
being carried out under the common law. Its most significant
elements in a clinical setting may prove to be the introduction
of powers for us all to create lasting powers of attorney
with healthcare powers, allowing us to choose a representative
in advance to make decisions about our care. It also empowers
the Court to appoint Deputies with similar powers and provides
for a new independent consultee service who will need to
be consulted about serious medical treatment decisions
where a patient has no-one else to speak
for him.’
[ends]
