DNAR orders and Advanced Directives Flashcards
What must be true for the Doctrine of Double Effect to be lawful?
action must be appropriate treatment according to the Bolam principles
the motive must be to relieve suffering and not to shorten life
List 3 justifications for the withdrawal of treatment
Best Interests
Futility
Impracticality (eg. when it is physically impossible, counter-productive or impractical to provide treatment against the wishes of the patient, or through impediment)
What constitutes best interests?
includes not only physical health but financial interests, moral obligations, religious welfare, family relations etc
is determined by a balancing exercise of benefits/dis-benefits
may be different for procedures that are medically indicated rather than those that are not (eg. therapeutic vs contraceptive hysterectomy)
When is treatment futile?
if it cannot cure ot palliate the disease or illness in which the patient is suffering and thus serves no therapeutic purpose of any kind - no real prospect of success
there is no obligation to provide treatment that is medically futile
What are the 5 key principles of the Mental Capacity Act 2005?
1) Presumption of capacity (unless there is evidence to the contrary)
2) A person is not to be treated as unable to make a decision unless all practicable steps to help him have been taken without success
3) There is a right to make eccentric or unwise decisions
4) All actions/decisions under the act must be made in their best interests
5) Actions/decisions done to a person lacking mental capacity must be the least restrictive options
What are the components of capacity?
understand the information relevant to the decision
retain that information
weigh up information as part of making the decision
communicate the decision
How should families be involved with decisions relating to the mental capacity act?
for patients lacking capacity, the MCA requires consultation (if practicable and appropriate) with:
- anyone names by the person for consultation
- anyone engaged in caring for the person or interested in his welfare
Do NHS Trusts have a legal duty to consult with and inform patients if DNAR order is made?
yes
must be convincing reasons not to involve patient
What are Advance Decisions?
a communication by the patient regarding his/her decisions and choices regarding future medical treatment
with the intention that those decisions and choices should be respected if the patient subsequently suffers loss of mental capacity
What principles apply with regards to Advance Decisions?
1) the patient must be ‘adult’
2) the patient must understand the implications of their refusal
3) the decision to refuse must be freely made
4) the refusal must apply to the circumstances that pertain
5) the patient must have mental capacity
What must an Advance Decision be to be legally binding?
in writing
signed
witnessed
include a statement that the AD decision is to apply even if life is at risk
Limitations of Advance Decisions?
cannot refuse actions to keep a patient comfortable (eg. basic or essential care)
cannot stop staff offering you food and drink by mouth
cannot use it to request euthanasia or assistance with euthanasia or unreasonable treatment
