----- Original Message -----
Sent: Tuesday, April 19,
2011 9:43 AM
Subject: Re: Wills in the
ED
>>I
agree with Rowley; the days of paternalistic medicine are gone. If anybody's it
is the nurse's role to care for the whole patient. We are there to heal the
sick and arranging wills is not our job.
Days of
paternalistic medicine are not completely gone. When I'm the consultant on call
I'm responsible. It may be the nurse's role to care for the whole patient, but
if they don't know what to do (as in this case), it's my job to tell them. In a
situation like this, I'm not convinced that the nurse, social worker or
administrator would be much help. I also feel that we are there to do more than
heal the sick. We are also there to comfort the dying. (We are also there to
deal with people with no discernible illness and to explain to people that no,
if there's a 6 week wait to see a dermatologist they can't get seen straight
away by coming to an ED and that at best we know no more about dermatology than
their GP does. But that's another matter and is more of a contractual than an
ethical issue).
Given that testamentory capacity
may well be disputed, there is a bit of guidance:
In a judgment in the case of
Kenward v Adams,3 Mr Justice (later Lord) Templeman
stated:
“In the case of an aged
testator or a testator who has suffered a serious illness, there is one golden
rule which should always be observed, however straightforward matters may
appear, and however difficult or tactless it may be to suggest that precautions
be taken: [the rule is that] the making of a will by such a testator ought to
be witnessed or approved by a medical practitioner who satisfies himself of the
capacity and understanding of the testator, and records and preserves his
examination and finding.”
This is taken from http://nt6342.vs.netbenefit.co.uk/documents/PublishedBMJArticleAug07.pdf
which is an interesting article, but it centres around what a GP should do if
asked by a solicitor to assess testamentary capacity. The problem here I
suppose is that it's quite difficult to get a solicitor at 2 am. There is also
the slightly awkward question of which medical practitioner should be doing the
assessing. Despite the earlier part of this post, I take Chris Kirke's point on
board about what our job is: should we by tying up one of our staff dealing
with this when there are sick patients to be seen? Or should the on call
consultant be coming in at night? And if so, should this be part of NHS duties?
(I don't know for certain, but my guess is that most GPs will charge for a
testamentory capacity assessment) Or is there someone else with more expertise
in the field who should be doing it? And on the practical side, how do you get
hold of a solicitor for this out of hours? I'd guess that that's one that the
patient can do for themselves or the hospital manager can help out with, but
anyone know if there's a straightforwards way of doing it?
Matt Dunn
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