Ethical Issues for Neurological Patients

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Ethical Issues for Neurological Patients

• Dr Lynne Russon
• Consultant in Palliative Medicine.
• Bradford 2nd May 07

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Four principles of medical ethics

1. Beneficence.
2. Non maleficence.
3. Autonomy.
4. Justice

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Neurological Patients

• Informed consent
• Assessing capacity
• Withdrawing and withholding treatment

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Definition

• Informed Consent
• A voluntary, uncoerced decision made by a
  sufficiently competent or autonomous person on
  the basis of adequate information and
  deliberation, to accept rather than reject some
  proposed course of action.
• (Gillon 1986)

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• Adequate time for deliberation not likely if
  emergency proceedure
• Adequate information for each individual
• Patient must be considered competent.

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BMAs Guidelines for Competence

• A competent individual should
• Understand in broad terms and simple language,
  what the treatment is, its purpose and nature and
  why it has been proposed.
• Understand its principal benefits, risks and
  alternatives.
• Understand in broad terms, what are the
  consequences of not receiving the proposed
  treatment.

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Competence cont.

• Make a choice free from undue pressure.
• Retain the information long enough to make an
  effective decision.

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Mental Capacity Act 2005

• Became law in April 07 but most needs to be
  applied by Oct 07.
• Defines how to assess capacity decision specific
  
  
  
• Explains how to assess best interests- people
  involved in caring gain a right to be consulted.

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Mental Capacity Act cont.

• Lasting powers of attorney (Enduring power
  of attorney)
• Court appointed deputies
• New court of protection
• Advanced decisions to refuse treatment

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Withdrawing and WitholdingTreatment

• Act vs Omission
• James Rachels argument

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WITHHOLDING AND WITHDRAWING TREATMENT

• BMA Guidelines 1999 updated 2001 to include
  Human Rights Act
• GMC Guidelines Witholding and withdrawing life
  prolonging treatment good practice in decision
  making.

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WITHHOLDING AND WITHDRAWING TREATMENT

• Basic Care
• Life prolonging treatment
• PEGs?
• Benefits and burdens equations
• Consider in terms of the four principles

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Burke 2005

• Leslie Burke 46 Cerebellar ataxia
• Challenged the GMCs guidance
• High court
• Court of appeal
• House of Lords refused
• European court of human rights Aug 06

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Practical Implications

• Consent- allow time for deliberation and
  planning.
• Capacity- be aware of the 07 act and help
  patients to make their own decisions
• Withdrawing treatment-set goals and guidelines
  before you start.

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