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Wise words from Rob Cocks and Ray McGlone. As Simon Bell in his original scenario pointed out its an old chestnut. Sadly some doctors dealing with such patients (usually junior....and especially some of the psychiatrists) are unable to apply what the law states into the real world of Emergency Medcine....i.e. what to do in your dept! My colleagues and I from Leicester published a very similar scenario based paper in the BMJ as a Lesson of the Week: - Managing patients who commit deliberate self harm and refuse essential medical treatment in the A&E department - (BMJ 1999;319:107-109 (10 July ) Hassan TB, MacNamara AF, Davy A, Bing A, Bodiwala GG. - Managing patients who commit deliberate self harm and refuse essential medical treatment in the A&E department - Letter: Authors' reply. BMJ 1999;319: 917. The really interesting stuff came out in the subsequent debate on the electronic BMJ - some of the letters (and our responses) became rather heated. The bottom lines were / are : 1)The defence unions find this an equally challenging problem. 2)Psychiatrists (those who write to the eBMJ anyway) can get very upset. Some of them think they are experts in the field and are NOT! 3)You have to balance your duty of care against the rights of the patient in that particular scenario. 4)It is probably very rare to meet a patient who is truely competent in such circumstances ( I have met a Professor of Law who had taken an overdose and proved a little more challenging!!) 5) Competence is your interpretation (and a second senior colleague's). If you decide that the patient is unble to WEIGH the issues in the balance and is not competent that is your decision. Believe in yourself and your commonsense. There has been no test case - and from speaking to colleagues in law - is unlikely to be, a case where a judge will find in favour of the plaintiff for saving his life if you thought he was not competent. 6)Do not give up on your patient under any circumstances! Almost all ( and certainly all in my experience....once you take out those who are being manipulative) WILL respond to persuasion and tact. This requires senior medical and nursing staff to put in time and effort. Its what will test your skills of being a good doctor! Hope that's of some help to this debate... Taj ===== Dr Taj Hassan Consultant in A&E Medicine Dept of A&E Medicine Leeds General Infirmary Leeds LS1 3EX, UK Work email: [log in to unmask] Tel : (0113) 392 6470 Fax : (0113) 392 2810 __________________________________________________ Do You Yahoo!? Thousands of Stores. Millions of Products. All in one Place. http://shopping.yahoo.com/ %%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%