Hannah Jones has refused the heart transplant that could save her life. But is a 13-year-old too young to make that decision? Or is she the only person who can?
The following guidance is for PCTs, local authorities, hospitals and care homes to support them understand and fulfill their statutory obligations under the Mental Capacity Act Deprivation of Liberty Safeguards legislation.
The aim of this guideline is to inform health and social care professionals on how best to manage advance care planning (ACP) in clinical practice. At the core of current health and social care are efforts to maximise individuals’ autonomy, promote patient-centred care, offer choice and the right to decide one’s own treatment or care. This can be difficult to achieve when an individual has lost capacity – the ability to make their own, informed decision. ACP is one method of enhancing autonomy, not only where an individual has lost capacity, but also by focussing discussion on the individual’s values and preferences throughout the time they are in contact with health or social care professionals. Whilst ACP has been used for some time in North America, there has been relatively little experience in the use of ACP in the UK. This set of concise evidence-based guidelines has therefore been prepared to guide practitioners.
This site explains how the law now allows people to make decisions to refuse treatments including those that sustain life. Many people want to achieve a natural and dignified death, this is one way to help achieve it. This is a free and non-profit NHS website. We suggest people enter the site using the relevent menu section (above). Many people benefit from looking at both sections.
The issue in this case is not uncommon. P is an adult who has an unresolved medical condition, in this case epilepsy. His primary carer, however well motivated, does not accept the diagnosis nor the treatment proposals. P may object to treatment (whether his own view or prompted by his carer). In order to determine what is in P's best interests, since he cannot decide for himself, it is necessary to observe him, and not to rely upon what is relayed about his condition by his carer. To that end, a period in hospital for assessment and treatment is necessary.
A fundamental aspect of the Mental Capacity Act 2005 (MCA) is the statutory endorsement of a functional approach to capacity. In principle, this requires a separate assessment of capacity in respect of each decision to be made. Most capacity assessments take place at a non-judicial level, and, outside of day-to-day decisions, the most common assessors are likely to be healthcare professionals. This paper investigates the practical operation of the capacity assessment process at both judicial and non-judicial levels. It asks whether the process can deliver on the MCA's goal of preserving maximum decision-making freedom, while, at the same time, providing an appropriate degree of protection. It argues that assessors who are not legally trained encounter signific
Doctors were forced to allow a young woman to die as she had made a "living will" requesting no medical help if she attempted suicide. They would have risked breaking the law by treating Kerrie Wooltorton, 26, of Norwich, an inquest heard. Miss Wooltorton wrote her living will in September 2007, asking for no intervention if she tried to take her own life.
Following advance directives in emergencies throws up some complicated problems, as Stephen Bonner and colleagues found. We asked an emergency doctor, a medical defence adviser, and an ethicist what they would do in the circumstances
Sir Terry Pratchett has said he's ready to be a test case for assisted suicide "tribunals" which could give people legal permission to end their lives. The author, who has Alzheimer's, says he wants a tribunal set up to help those with incurable diseases end their lives with help from doctors. A poll for BBC One's Panorama suggests most people support assisted suicide for someone who is terminally ill.
Doctors will be allowed forcibly to sedate the 55-year-old woman in her home and take her to hospital for surgery. She could be forced to remain on a ward afterwards. The case has sparked an intense ethical and legal debate. Experts questioned whether lawyers and doctors should be able to override the wishes of patients and whether force was ever justified in providing medical care.
A cancer patient who has a phobia of hospitals should be forced to undergo a life-saving operation if necessary, a High Court judge has ruled. Sir Nicholas Wall, sitting at the Court of Protection, ruled doctors could forcibly sedate the 55-year-old woman - referred to as PS. PS lacked the capacity to make decisions about her health, he said. Doctors at her NHS Foundation trust had argued PS would die if her ovaries and fallopian tubes were not removed. Evidence presented to Sir Nicholas, head of the High Court Family Division, said PS was diagnosed with uterine cancer last year.
The 30-year-old, known only as SB, could die without emergency treatment for aplastic anemia, a condition in which her bone marrow does not reproduce enough new blood cells. The Court of Protection has now ruled that doctors can restrain SB and force her to undergo the arduous but potentially life-saving treatment, which is administered through a vein in the heart and lasts for five days. SB has been detained under the Mental Health Act. Family Division judge Mrs Justice Hogg ruled that the patient did not have the capacity to make up her own mind over whether to undergo the treatment.
A high court judge in England has ordered that doctors can force a woman without the capacity to decide for herself to have lifesaving treatment for aplastic anaemia. Mrs Justice Hogg made the ruling in the Court of Protection after an unnamed NHS trust applied to the court with the backing of the Official Solicitor, who looks after the interests of those lacking capacity. The judge said the 30 year old woman, named only as SB, who is detained under the Mental Health Act, has a serious psychiatric disorder and lacks the capacity to decide for herself whether or not to have the potentially lifesaving treatment.
A controversial court that still holds its hearing in private will decide tomorrow whether a pregnant woman with learning difficulties should be forcibly sterilised once she gives birth. Health workers from a local NHS trust and council, who cannot be named for legal reasons, have asked the secretive Court of Protection to decide whether the woman should be forced to have her fallopian tubes cut to stop her falling pregnant again.
A woman with "severe" anorexia who wanted to be allowed to die is to be force fed in her "best interests" by order of a High Court judge. Mr Justice Peter Jackson declared that the 32-year-old from Wales, who cannot be identified, did not have the capacity to make decisions for herself. He made public his judgment on Friday after making the ruling last month.
The family of a man left in a vegetative state after a heart attack has made an eleventh hour appeal for doctors to do all they can to keep him alive as they await a vital court ruling. Tomorrow, the court of protection in London will be asked to rule in a dispute over whether it is in "the best interests" of the severely brain-damaged man, who is from the Greater Manchester area, to continue to receive life-saving treatment if his condition deteriorates. Pennine Acute Hospitals NHS Trust claim it is not in the best interests to offer the man, known only as L, ventilation or resuscitation if his condition worsens and he suffers "a life-threatening event", such as another heart attack. But his family disagree and say they, not the trust, must be given the right to decide on his care.
A High Court judge has ruled in favour of an NHS trust that force feeding would not be in the "best interests" of an anorexic woman. Mrs Justice King, at the Court of Protection in London, heard that the 29-year-old woman, who weighs about 3st 2lb (20kg), does not wish to die. She ruled "all reasonable steps" should be taken to gain the woman's co-operation, without "physical force".
A lady has cancer of the uterus. She could be cured by a potentially life-saving operation. However, because of other co-morbidities and other factors there is a considerable risk that she could die during the operation or in the post-operative recovery period. She herself lacks the capacity to make an informed decision, but she denies that she has cancer at all and opposes and is resistant to the operation. The medical team at the hospital consider that she would benefit from the operation and would like to perform it. The lady's three adult sons all strongly desire that she should have the operation and feel that the potential benefit outweighs the risk. The Official Solicitor, who acts as her litigation friend, considers, in a phrase, that it is too risky. The question for the court is whether, balancing all the relevant factors, it is in her overall best interests to have the operation or not.
Although DJ's condition is in many respects grim, I am not persuaded that treatment would be futile or overly burdensome, or that there is no prospect of recovery. (a) In DJ's case, the treatments in question cannot be said to be futile, based upon the evidence of their effect so far. (b) Nor can they be said to be futile in the sense that they could only return DJ to a quality of life that is not worth living. (c) Although the burdens of treatment are very great indeed, they have to be weighed against the benefits of a continued existence. (d) Nor can it be said that there is no prospect of recovery: recovery does not mean a return to full health, but the resumption of a quality of life that DJ would regard as worthwhile. The references, noted above, to a cure or a return to the former pleasures of life set the standard unduly high.
The landmark decision of Gillick v West Norfolk Area Health Authority was a victory for advocates of adolescent autonomy. It established a test by which the court could measure children's competence with a view to them authorising medical treatment. However, application of the test by clinicians reveals a number of ambiguities which are compounded by subsequent interpretation of Gillick in the law courts. What must be understood by minors in order for them to be deemed competent? At what point in the consent process should competence be assessed? Does competence confer on minors the authority to refuse as well as to accept medical treatment? These are questions which vex clinicians, minors and their families. A growing number of commentators favour application of parts of the Mental Capacity Act 2005 to minors. In this paper, the limitations of this approach are exposed and more radical reform is proposed.
New report finds half of dying Britons are not dying well At a pivotal time for end of life care in Britain the need for advance care planning is reinforced Divided in Dying, a new report from charity Compassion in Dying, finds that almost half of those who have lost someone close to them through a short or long illness, feel their loved one died badly (45%). In cases where the dying person had recorded their end of life wishes, relatives and friends are more likely to report that they had a good death (58%). Alongside recording end of life wishes (19%), better communication between the doctor and their loved one (39%), co-ordination of care (33%) and being able to die in a place of their choice (31%) were also identified as key aspects which could have improved the situation for the person who died in a bad way. Compassion in Dying surveyed over 2400 British adults who were asked to recall the experience of the last relative or close friend who died.
25th July 2013: The Mental Capacity Act (MCA) made Advance Decisions to refuse treatment legally binding in statutory law in 2005, and Compassion in Dying has been providing free information on end of life and Advance Decision forms since 2010. A new study, which looked at in excess of 200 calls to Compassion in Dying, found that a major barrier to patients exercising choice was doctors’ failure to engage with patients about their Advance Decision and the lack of systems in place to record them. Two callers reported considering a ‘DNR tattoo’ as a way of addressing this problem. The study also found women (84% of callers) are more likely than men (16%) to make their wishes known at the end of life. Professor Sue Wilkinson, author of the report and Professor of Feminist and Health Studies in the Department of Social Sciences at Loughborough University said: “This study has led to a number of recommendations for Compassion in Dying, and more broadly for the integration of Adva...
This is an application by a NHS Trust for declaratory relief in respect of a man (whom I shall call "Dr. A") who is on hunger strike in the Trust hospital. The relief sought by the Trust is in short a declaration : (i) that he lacks capacity to litigate and to make decisions in respect of his nutrition and hydration; and (ii) that it is lawful for the Trust to administer artificial nutrition and hydration.
This is an application made by the NHS Foundation Trust in the Court of Protection for a raft of declarations in relation to a young man, M, who was born on 19th June 1990 and so approaches his 23rd birthday. M was tragically born with a congenital abnormality of the brain called holoprosencephaly ("HPE"). It is common ground that in the period of time since 2010 M's condition has significantly deteriorated. He is now seriously malnourished and, in the view of both the treating physicians and independent experts instructed for the purposes of this hearing, reaching the end of his life. The painful and difficult issues now to be faced by M's family, the medical team that have cared for him so diligently over many years, and ultimately this court, is to what extent should M be treated in Intensive Care or be given cardio-pulmonary resuscitation ("CPR") in the event that there is a further deterioration in his condition. There is no question of M having the capacity himself to make...
Judge approves forced Caesarean for mentally-ill woman Doctors have been granted permission to perform an urgent Caesarean section on a mentally-ill woman with diabetes. High Court judge Mr Justice Hayden gave specialists at the Royal Free London NHS Trust approval after a five-hour hearing at the Court of Protection. He said the decision was "draconian" but necessary because the mother's life may be in danger. The woman, 32, who is 32 weeks pregnant, was deemed unable to make the decision over how to give birth. The ruling, late on Friday, came after doctors applied for permission to carry out the delivery in order that the patient's "unstable mental state" could be treated. A specialist from the trust told the Court of Protection in London, which specialises in issues relating to the sick and vulnerable, that their priority was "keeping this woman alive".
National clinical guidelines on the care of people in a vegetative or minimally conscious state, following severe brain injury These long-awaited guidelines will be a major contribution to clinical and ethical standards of care for this group of patients, not only in the UK but internationally. For England and Wales, they provide much needed clarity on legal decision-making. You can buy a print copy of the guidelines (130 pp, £15) from our online shop, or download a free PDF below. The guidelines were developed by a panel of experts in the field, who have organised complicated and wide-ranging information into six coherent sections: 1 Defining criteria and terminology 2 Assessment, diagnosis and monitoring 3 Acute to longer-term management 4 Ethical and medico-legal issues 5 End-of-life issues 6 Service organisation and commissioning Each section is followed by a set of clear recommendations.