Thursday, 27 May 2010

Medical Ethics? What Medical Ethics?

Isn't it nice to know that no matter what your personal circumstances, there's always a support or pressure group or advocate somewhere that will stand up for your rights?

It seems that doctors wish to forcibly treat a woman with learning difficulties who has cancer and does not wish surgery. Step forward the disability network to uphold her rights and...

Oh. Wait.
Last night Liz Sayce, chief executive of Radar, the disability network, said: “The right to refuse treatment is a cornerstone of human rights and medical ethics, but so too is the duty of care.”The head states that saving the woman’s life is right; the heart recoils at the thought of deceiving and compelling her into undergoing a procedure which she does not want.”
Is it me, or is there a sense of 'mustn't upset the apple cart' about that statement?
“Society, however, must be careful to treat every case individually, and ensure that this case provides no precedent for over-riding the consent of people with learning disabilities in future.”
In other words, 'oooh, we'll let you do this just the once, but don't get too cheeky in the future!'.

Naturally, some medical professionals are 'what's all the fuss here? we do it all the time!' about this:
Dr Evan Harris, a former member of the Commons Science and Technology committee, said: “In A&E departments up and down the country, patients without capacity such as those drunk, drugged, psychotic, confused or with dementia are treated seemingly against their will, day in and day out. Learning disability coupled with needle or hospital-phobia in a patient with cancer needing is unusual but is a relatively routine matter for clinical ethics.”
It seems mental health campaigners aren't the only ones who've lost sight of what they are supposed to stand for...

Via UK NewsNetwork .

Update: MummyLongLegs has a piece of her mind for the medical establishment too...

14 comments:

Chalcedon said...

If a patient presented to me and required a blood transfusion but didn't want it on religious grounds, for example, they would get one anyway. Under anaesthetic if necessary. The duty of care is to save life (always allowing judgement regarding brain dead patients and the like of course). They guy in A&E is spot on. You don't wait for the unconcious or comatose to come round before you treat them.

JuliaM said...

@Chalcedon: You'd be breaking the law, if that patient was conscious, mentally competent, an adult and made their wishes clear.

And that's as it should be.

opsimath said...

Chalcedon, that is outrageous and indefensible, as well you know.

Umbongo said...

JuliaM

You're obviously too immature to decide your own fate. I'm surprised you are able to function at all. In your interests - all our interests - Chalcedon displays a higher morality which insists that when you decide against his/her judgement (in his/her area of "professional" expertise) you are, by definition, neither mentally competent nor adult.

Chalcedon said...

Obviously not mentally competent by refusing a transfusion when it was necessary. And there have been cases where a parent takes a similar decision regrarding their child and once the parent is out of the picture, the child gets treated. If the patient is judged to be incompetent then treatment is allowed under English common law.

JuliaM said...

@Chalcedon:"Obviously not mentally competent by refusing a transfusion when it was necessary."

I really, REALLY don't think we want to make that the guage of mental incompetence, do we?

Is it just me (and MummyLongLegs - will link when I get home) who sees the slippery slope and yawning chasm below here?

woman on a raft said...

I'm waiting for the published judgment, which I think most of the legal commenters are, because it looks like the newly-appointed Lord Wall has fallen down the classic catch-22 hole previously occupied by Justice Hogg when she was hustled in to authorizing a caesarean section against the wishes of what turned out to be a competent adult.

It all hangs on Lord Wall demonstrating how he established lack of mental capacity to consent and whether he reached the right conclusion. This might be why the charity spokesperson seemed to haver about; it's the crucial piece of information. That was rubbish, though, about 'cornerstones' because the autonomy of compent adults, which is the default case, trumps duty of care and even trumps best interests of the individual. The cases of minors, those without the capacity to consent etc. are all exceptions which suspend the general rule, if they can be shown to apply. This usually involves going quickly to court to seek the permission of the court to act in what would otherwise be an unlawful fashion. Perhaps the best known case is of the conjoined twins "Jodie and Mary".

In 1998 the Court of Appeal summarized previous rulings and emphasized: if a competent adult wishes to refuse treatment, they can. The refusal of itself can't be used in a circular fashion to show the person lacks mental competence (despite what Chalcedon thinks).

Yesterday's judgment is reported to refer to s.1 of the Mental Capacity Act 2005 and may test the definitions in that act. However, the principles of the Act are clear:

s.1 (4) A person is not to be treated as unable to make a decision merely because he makes an unwise decision.

My immediate impression was that the hospital was happy to rely on her consent to surgery when she was giving them permission, so they must have accepted she had the capacity to consent. However, as soon as she withdrew that consent, they tried to apply the circular argument that this proved she lacked capacity, which is wholly contrary to 1.(4).

sobers said...

Re: lack of interest from 'rights' groups - don't you realise that only the criminal element of society have 'rights'? The rest of us just get to do as we are told by people like Chalcedon.

Gotta love that argument though Chalcedon - your decisions are obviously correct, and therefore by definition anyone who disagrees with you cannot be competant to make a decision. You therefore can over-ride their wishes.

Is it lonely up there on Mount Olympus?

MTG said...

”The head states that saving the woman’s life is right; the heart recoils at the thought of deceiving and compelling her into undergoing a procedure which she does not want.”

Hard to fault the above statement and its further qualification, yet JuliaM's point is valid, Umbongo.

Are things much different in the German Camps, mein Furor?

Chalcedon said...

I'm not advocating sectioning just because it is convenient or because people have the 'wrong politics'. There are ethics committees just as their are healthcare professionals who work for the CIA at Gitmo.

JuliaM said...

@WoaR: That acceptance of consent to the surgery initially should certainly be considered crucial...

@Chalcedon: Perhaps that's the problem? This woman is evidently under the 'care' of someone who hasn't been retrained yet after an overseas posting....

John R said...

@JuliaM "Is it just me (and MummyLongLegs - will link when I get home) who sees the slippery slope and yawning chasm below here?"

Nope, I'm with you. Chalcedon is already way, way down the slippery slope here. She(?) feels she has the right to decide what's good for you based on her own ideas not the law. If she thinks something's is ok and you dont then, merely by disagreeing with her, you are not mentally competent. This is straight out of the Soviet era playbook where dissent got you locked up in a mental ward as you were obviously insane merely by disagreeing with the state.

What if Chalcedon decides (IN HER OPINION!) single mothers are at risk and that their pregnancies are a danger to their health. Do they then automatically get an abortion, no matter how hard they protest, when they visit her ward?

I really would not wish to visit any hospital where she was a physician.

woman on a raft said...

Here's the judgment. I haven't read it yet.

Neutral Citation Number:
[2010] EWHC 1217
(Fam)Case No: 11829453

DH NHS Foundation Trust
Applicant
- and -
PS (By her litigation friend, The Official Solicitor)

JuliaM said...

"This is straight out of the Soviet era playbook where dissent got you locked up in a mental ward as you were obviously insane merely by disagreeing with the state."

As Anna Raccoon points out, that attitude hasn't gone away. In fact, it's spread to this country...

"Here's the judgment. I haven't read it yet."

Cheers!

This was an odd bit: "I am also satisfied that it would be inappropriate for PS to undergo an MRI scan. "