Quite right Adrian, but the hoops patients have to jump through to make
an advanced directive binding, particularly in the field of emergency
medicine, make them quite rare.
I would certainly ignore a piece of paper, even if signed and apparently
witnessed, stuck to a patient's chest with a DNAR directive on it. If a
patient is serious about not wanting to be resuscitated then their
wishes most certainly should be respected.
However, my understanding of being "serious" about their treatment
requires...
Information (of accepted practice and alternatives if applicable) in a
form the patient can comprehend,
Capacity to weigh the information and come to a decision,
The wish is sustained over time and subject to review (? how often),
Specific details about what circumstances the directive applies to,
No coercion (obviously)
Best practice also dictates involvement of family, witnesses and a
second senior opinion.
In practice, this means that a patient who really doesn't want certain
emergency treatment (resus or otherwise) is required to discuss their
wishes at least twice in advance with at least 1 consultant in A&E,
their GP, their relatives, +/- their solicitor, to lodge a formal
witnessed statement specifying unambiguously what they do or don't want
in the A&E department (and GPs surgery), and to be willing to have their
decision ratified periodically. See what I mean about hoops. If they do
all this, then treating them against their wishes would invite
accusations of battery.
I know of no patients at my unit who are that "serious". There must be
docs out there who have patients on their books with valid ADs. I'm as
interested as Gerry McArthy to know if the USA suit was succesful. I
don't think it would have got very far in the U.K. There are also some
medicolegal lawyers lurking I believe. Come on guys: give us your two
penny-worth!
Goat
In article <[log in to unmask]>,
[log in to unmask] writes
>> from: "Dunn Matthew Dr.
>> My understanding is that there is no specific legal status of a living will
>> regardless of its form.
>
>Not quite true Matt; while there is no statutory duty to comply with advance
>directives, the general principles have been endorsed by both the BMA and
>Government. Thus you would be wide open to successful litigation if you chose
>to
>ignore a bone-fide advance directive. This hasn't yet been tested in case law
>but the implications appear fairly clear to me, i.e. I would comply with such a
>directive.
>
>Adrian Fogarty
Dr G Ray
A&E
Sussex
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