Ethical Issues for Neurological Patients

Dr Lynne Russon Consultant in Palliative Medicine.

Bradford 2 nd May 07 1

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Four principles of medical ethics

Beneficence.

Non maleficence.

Autonomy.

Justice 2

Neurological Patients

   Informed consent Assessing capacity Withdrawing and withholding treatment 3

Definition

Informed Consent

A voluntary, uncoerced decision made by a sufficiently competent or autonomous person on the basis of adequate information and deliberation, to accept rather than reject some proposed course of action.

(Gillon 1986) 4

   Adequate time for deliberation not likely if emergency proceedure Adequate information for each individual Patient must be considered competent.

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BMA’s Guidelines for Competence

A competent individual should:  Understand in broad terms and simple language, what the treatment is, its purpose and nature and why it has been proposed.

 Understand its principal benefits, risks and alternatives.

 Understand in broad terms, what are the consequences of not receiving the proposed treatment. 6

Competence cont.

 Make a choice free from undue pressure.

 Retain the information long enough to make an effective decision. 7

Mental Capacity Act 2005

   Became law in April 07 but most needs to be applied by Oct 07.

Defines how to assess capacity – decision specific Explains how to assess best interests people involved in caring gain a right to be consulted.

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Mental Capacity Act cont.

    Lasting powers of attorney (Enduring power of attorney) Court appointed deputies New court of protection Advanced decisions to refuse treatment 9

Withdrawing and WitholdingTreatment

Act vs Omission James Rachel’s argument 10

WITHHOLDING AND WITHDRAWING TREATMENT

  BMA Guidelines 1999 – updated 2001 to include Human Rights Act GMC Guidelines ‘Witholding and withdrawing life prolonging treatment; good practice in decision making.’ 11

WITHHOLDING AND WITHDRAWING TREATMENT

Basic Care Life prolonging treatment

PEGs?

Benefits and burdens equations Consider in terms of the four principles 12

Burke 2005

      Leslie Burke 46 Cerebellar ataxia Challenged the GMCs guidance High court Court of appeal House of Lords refused European court of human rights Aug 06 13

Practical Implications

   Consent- allow time for deliberation and planning.

Capacity- be aware of the 07 act and help patients to make their own decisions Withdrawing treatment-set goals and guidelines before you start. 14

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