Musings: Some excerpts from law and guidance – SECOND ATTEMPTED CORRECTION

Yet another attempt, to persuade this website to actually post the full contents of the 'submit' box!

This is the final part of section 14 from ‘Treatment and care towards the end of life: good practice in decision making’ which was published by the GMC on 20th May 2010, and came into force 1 July 2010.

14(d) If the patient asks for a treatment that the doctor considers would not be clinically appropriate for them, the doctor should discuss the issues with the patient and explore the reasons for their request. If, after discussion, the doctor still considers that the treatment would not be clinically appropriate to the patient, they do not have to provide the treatment. They should explain their reasons to the patient and explain any other options that are available, including the option to seek a second opinion or access legal representation.

The previous sections dealt with the patient's acceptance of treatment:

(b) The doctor uses specialist knowledge and experience and clinical judgement, and the patient’s views and understanding of their condition, to identify which investigations or treatments are clinically appropriate and likely to result in overall benefit for the patient. The
doctor explains the options to the patient, setting out the potential benefits, burdens and risks of each option. The doctor may recommend a particular option which they believe to be best for the patient, but they must not put pressure on the patient to accept their advice.
(c) The patient weighs up the potential benefits, burdens and risks of the various options as well as any non-clinical issues that are relevant to them. The patient decides whether to accept any of the options and, if so, which. They also have the right to accept or refuse an option for a reason that may seem irrational to the doctor or for no reason at all.


I consider that section 14 of that guidance (unlike certain other sections) is both clear, and legally correct.
It is interesting to consider (in the context of ‘what does ‘acting in the patient’s best interests’ mean, since both the MCA and section 14 have been published), where the author uses the phrase ‘likely to result in overall benefit for the patient’, that the phrase ‘best interests’ is never used, and that section (d) is very careful to only use the term ‘clinically appropriate’. This is one of the very few sections of the clinical publications relating to EoLC decision-making, which I could have written myself (probably with the same incorrect usage of ‘their’ and ‘they’ !): although, it disturbs me that the principle of Informed Consent, needs to be spelt out in terms a 10 yr old could understand, in a publication intended for doctors !

It is also interesting to consider the purpose of the MCA. For patients who ‘are mentally capable until a CPA, or who only become mentally incapable during a predictable clinical deterioration’, surely the presence of section 4(6) in the Act supports the idea that the A