Musings - The end of 'second attempt' which refused to post !

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 Act is merely seeking to extend section 14(c) of that GMC guidance (the requirement to obtain consent for treatment) into the period of mental incapacity ? (section 14(c) comes from a court case in the 1990s, which made the test for a valid refusal only ‘does the patient understand the clinical consequences of his decision ?’ – there is no consideration of ‘is it a ‘good’ decision, or a 'sensible' decision ?’).
In which case, surely anybody who is faced with a patient in CPA (clinicians or laymen) must consider the question ‘Am I certain beyond any reasonable doubt, that he would tell me to let him die in peace without intervention, if I could somehow both ask him the question, and inform him of anything relevant he is not already aware of ?’. If you can honestly answer ‘Yes – I’m sure he would refuse treatment’ then you should just let him die in peace, but if you cannot be sure of that answer, then you should try to keep him alive. If you can honestly answer 'He would have refused CPR, had he been able to somehow do that' then your decision is the right one (see section 4(9) of the MCA).
This moves the problems for EoLC/CPR/VoD into somewhat different areas, from those assumed to be the correct ones by the current clinical guidance – I will explain, if I get enough detailed responses to the ‘Musings’ series.