Week 2- Advance Decisions to Refuse Treatment and Advance Care Planning Flashcards
What is the advantages of ACP?
Planning ahead allows for care to be accessed safely, at the right time and with continuity of delivery
Can avoid the conflicts and tensions that arise between doctors, patients and relatives during emotionally fraught times
Can help in determining right course of action if capacity is lost
What should the ACP discussion include?
Patient’s wishes, preferences or fears in relation to future treatment or care
Feelings, beliefs or values influencing the patient’s preferences and decisions
Family members, or others close to the patient or any legal proxies that the patient would like to be involved in decisions about their care;
Interventions that may be considered or undertaken in an emergency, such as CPR.
Is the ACP legally binding?
ACP is not legally binding
Document is taken into account when deciding what is of overall benefit if patient loses capacity
What are the 3 types of Advanced decisions?
- Advance requests for treatment
- Advance refusal of treatment
- Decisions about CPR
Why might a patient make an advance request for treatment?
A patient may weigh up risks/benefits differently from healthcare professionals
Apatient may want treatment that healthcare professionals consider to be inappropriate
Apatient may therefore be worried that, if they lose capacity, treatment that they consider to be worthwhile will not be given to them
Advance request for treatment
a) are they legally binding
b) is a Dr obliged to follow it?
a) Are not legally binding
b) Doctor is not required to provide a treatment simply because a patient askes for it, if the doctor does not think it is in the patient’s best interests.
But the doctor must be able to justify why it is not in the patient’s best interests
If an advanced request for tretament cannot be ignored how should tx decision be made?
- Treatment decisions should be made on the grounds of providing overall benefit
- Overall benefit depends upon patient’s wishes and preferences
- The Advance Request is evidence of these, so must be given weight
- When burdens and benefits are finely balanced, an Advance Request may be the deciding factor
Advance Refusal of treatment- why may some people refuse?
Their concerns may relate to what is involved with specific treatments
Or further treatments/quality of life issues following the treatment.
When is an advance refusal of treatment legally binding?
It is valid
It is clearly applicable to the patient’s current circumstances
If an Advance Refusal meets the requirements of the Mental Capacity Act (MCA), it must be respected in the same way that a refusal of treatment by a person with capacity would be.
When is ADRT not valid?
The person has withdrawn the advance decision since making it.
Since making the decision the person has created a Lasting Power of Attorney for health and welfare giving someone else the authority to refuse or consent to the treatment in question.
The person has done anything that is clearly inconsistent with the advance decision remaining their fixed decision.
What are the other requirements for a valid ADRT?
- Over 18yrs when decision was made
- Patient had capcity to make the decision at the time it was made
- Not subject to undue influence in making the decision
- Decision was made with adequete information
Applicability of ADRT- what must is state
- Precisely what treatment is to be refused
- Circumstances when the refusal should apply
- May specify particular circumstances when the decision to refuse treatment should not apply
May not be applicable if there are reasonable grounds for believing that circumstances exist which the patient did not anticipate and which would have affected their decision if anticipated, for example any relevant clinical developments or changes in the patient’s personal circumstances since the decision was made
When does the ADRT apply?
Will only apply at a time when the person lacks capacity to consent to or refuse the specific treatment.
ADRT what format can they be in?
Can be verbal rather than written
What are the criteria to refuse life sustaining treatment?
The decision must be written
The decision must be signed by the person making it
The decision must be witnessed
The decision must specify that the treatment is potentially life sustaining, that is death could result from the refusal