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Ethical Issues for Neurological Patients

Dr Lynne Russon Consultant in Palliative

Medicine.

Bradford 2nd May 07

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Four principles of medical ethics

1. Beneficence.2. Non maleficence.3. Autonomy.4. Justice

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Neurological Patients

Informed consent Assessing capacity Withdrawing and withholding

treatment

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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)

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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.

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Competence cont.

Make a choice free from undue pressure.Retain the information long enough to make an effective decision.

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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

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Withdrawing and WitholdingTreatment

Act vs Omission

James Rachel’s argument

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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.’

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WITHHOLDING AND WITHDRAWING TREATMENT

Basic CareLife prolonging treatmentPEGs?Benefits and burdens equations Consider in terms of the four

principles

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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

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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.

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