Consent may be hard to obtain for incompetent patients when relatives object

Morris, Edward

doi:10.1136/bmj.316.7144.1608

Cited by 5 publications

(4 citation statements)

References 1 publication

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“…The treating physician must document this clearly in the clinical note. Such emergency should trigger the ‘doctrine of necessity’, in which any action taken should be limited to save the life of the individual or to prevent further significant deterioration of the individual's condition . The MCA does not clarify the timeframe before which decisions can be made under the doctrine of necessity; however, it is reasonable to assume that once mental capacity has been assessed, this doctrine should be activated.…”

Section: Discussionmentioning

confidence: 99%

Decision‐making framework in gynaecology for patients who lack mental capacity

Bolaji

Omih

Sze

2018

The Obstetric & Gynaecologis

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Key content Caring for and making decisions on behalf of incompetent adults can be a complicated process. The Mental Capacity Act (MCA) 2005 provides a legal framework that protects mentally incapacitated individuals and guides decision makers during the decision‐making process. A gynaecologist can easily undertake the determination of mental capacity using the two‐stage test of capacity. The best interests meeting is an appropriate way of facilitating the decision‐making process by bringing together the relevant people involved in the care of the individual who has lost decision‐making ability. Learning objectives To understand mental capacity in relation to the MCA 2005. To understand the test of mental capacity. To understand the different decision‐making models, as applied to mental capacity. To be able to apply the MCA statutory checklist in the determination of best interests. Ethical issues There may be conflicts of interest between the medical team and surrogate decision maker in the best interest meeting. A dispute among the members of the best interest team could delay the treatment of the mentally incapacitated individual, and such delay may not be in the best interest of the patient.

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Section: Discussionmentioning

confidence: 99%

Decision‐making framework in gynaecology for patients who lack mental capacity

Bolaji

Omih

Sze

2018

The Obstetric & Gynaecologis

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“…Indeed, the primary duty of a physician to their patient too arises from an agreement, often a tacit one, between the patient and the physician. Such an agreement exists even when dealing with an unconscious person who is unable to express their will at the time when care is called upon; for example, in jurisdictions with state provided health care the agreement is presumed, 49 and includes the duty of non‐intervention if an explicit a priori refusal of consent to be medically treated was made by the individual. Children, deemed incapable of making informed decisions in this regard, enter the agreement mediately, that is by virtue of their carers (usually parents) consenting to it on their behalf.…”

Section: Disentangling the Pvsmentioning

confidence: 99%

Resolving the ethical quagmire of the persistent vegetative state

Arandjelović

2023

Evaluation Clinical Practice

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BackgroundA patient is diagnosed with the persistent vegetative state (PVS) when they show no evidence of the awareness of the self or the environment for an extended period of time. The chance of recovery of any mental function or the ability to interact in a meaningful way is low. Though rare, the condition, considering its nature as a state outwith the realm of the conscious, coupled with the trauma experienced by the patient's kin as well as health care staff confronted with painful decisions regarding the patient's care, has attracted a considerable amount of discussion within the bioethics community.AimsAt present, there is a wealth of literature that discusses the relevant neurology, that elucidates the plethora of ethical challenges in understanding and dealing with the condition, and that analyses the real‐world cases which have prominently featured in the mainstream media as a result of emotionally charged, divergent views concerning the provision of care to the patient. However, there is scarcely anything in the published scholarly literature that proposes concrete and practically actionable solutions to the now widely recognized moral conundrums. The present article describes a step in that direction.Materials & MethodsI start from the very foundations, laying out a sentientist approach which serves as the basis for the consequent moral decision‐making, and then proceed to systematically identify and deconstruct the different cases of discord, using the aforementioned foundations as the basis for their resolution.ResultsA major intellectual contribution concerns the fluidity of the duty of care which I argue is demanded by the sentientist focus.DiscussionThe said duty is shown initially to have for its object the patient, which depending on the circumstances, can change to the patient's kin, or the health care staff themselves.ConclusionIn conclusion, the proposed framework represents the first comprehensive proposal regarding the decision‐making processes involved in the deliberation on the provision of life sustaining treatment to a patient in a PVS.

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“…Indeed, the primary duty of a physician to their patient too arises from an agreement, often a tacit one, between the patient and the physician. Such an agreement exists even when dealing with an unconscious person who is unable to express their will at the time when care is called upon; for example, in jurisdictions with state provided health care the agreement is presumed (Morris, 1998), and includes the duty of non-intervention if an explicit a priori refusal of consent to be medically treated was made by the individual. Children, deemed incapable of making informed decisions in this regard, enter the agreement mediately, that is by virtue of their carers (usually parents) consenting to it on their behalf.…”

Section: Duty Of Carementioning

confidence: 99%

Resolving the Ethical Quagmire of the Persistent Vegetative State

Arandjelović¹

2023

Preprint

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A patient is diagnosed with the persistent vegetative state (PVS) when they show no evidence of the awareness of the self or the environment for an extended period of time. The chance of recovery of any mental function or the ability to interact in a meaningful way is low. Though rare, the condition, considering its nature as a state outwith the realm of the conscious, coupled with the trauma experienced by the patient's kin as well as health care staff confronted with painful decisions regarding the patient's care, has attracted a considerable amount of discussion within the bioethics community. At present, there is a wealth of literature that discusses the relevant neurology, that elucidates the plethora of ethical challenges in understanding and dealing with the condition, and that analyses the real-world cases which have prominently featured in the mainstream media as a result of emotionally charged, divergent views concerning the provision of care to the patient. However, there is scarcely anything in the published scholarly literature that proposes concrete and practically actionable solutions to the now widely recognized moral conundrums. The present article describes a step in that direction. I start from the very foundations, laying out a sentientist approach which serves as the basis for the consequent moral decision-making, and then proceed to systematically identify and deconstruct the different cases of discord, using the aforementioned foundations as the basis for their resolution. A major intellectual contribution concerns the fluidity of the duty of care which I argue is demanded by the sentientist focus. The said duty is shown initially to have for its object the patient, which depending on the circumstances, can change to the patient's kin, or the health care staff themselves. In conclusion, the proposed framework represents the first comprehensive proposal regarding the decision-making processes involved in the deliberation on the provision of life sustaining treatment to a patient in a PVS.

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Consent may be hard to obtain for incompetent patients when relatives object

Cited by 5 publications

References 1 publication

Decision‐making framework in gynaecology for patients who lack mental capacity

Decision‐making framework in gynaecology for patients who lack mental capacity

Resolving the ethical quagmire of the persistent vegetative state

Resolving the Ethical Quagmire of the Persistent Vegetative State

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