This week the Court of Protection gave an NHS Board in
England permission to proceed with risky, but potentially life-saving, treatment
against a patient’s wishes. The patient,
known as Mrs K, had schizophrenia and held a ‘delusional belief’ that she did
not have cancer. Evidence demonstrated
she was unable to make an informed decision and her family were in agreement
that she should have treatment. However,
the solicitor appointed to represent her ‘best interests’ felt the surgery was
too risky.
This isn’t the first case to consider the treatment of an
incapable patient against their will. In 2010, the Court gave permission to
doctors to sedate a woman with learning disabilities and transfer her to
hospital for surgery against her express and consistent wishes. The sedative
would probably need to be concealed in a drink and she would be sedated for a
period following surgery to ensure she didn’t become agitated and leave.
These cases involve complex ethical dilemmas and place massive
emotional stress on families. When is it
acceptable to treat someone against their express wishes, if ever? What would the person have wanted? Which factors can legitimately be taken into
account? What weight should we give to
the views of families? On the one hand,
we often hear stories of profoundly disabled people effectively being denied
treatment or families finding DNR notices appearing on files with no
discussion. On the other, it’s crucial
not to underestimate the potential psychological damage of being sedated and
having invasive surgery against your wishes.
Perhaps we should all think about the circumstances in which
we would or wouldn’t want treatment and about the people we want to make
decisions for us, if we are ever unable to make our own. Living wills, advance statements and powers
of attorney are all vital tools we can use to make our wishes clear and guide
both our families and professionals about the decisions we want them to
make. These documents are at least as important
as your will, if not more so, given they affect decisions while you are
actually here!
Nicola
More information
1. The Court of Protection operates in
England. In Scotland, cases would be
heard by the Court of Session.
2. For anyone interested the 2010 case is DH
NHS Foundation Trust v PS [2010] EWHC 1217 and the Mrs K is as yet unreported
but there are more details here http://www.telegraph.co.uk/news/uknews/law-and-order/9609692/Woman-who-does-not-believe-she-has-cancer-can-undergo-operation.html
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