BMA annual representative meeting: Wishes of patients who have lost mental capacity must be respected
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《英国医生杂志》
Patients who have lost their mental capacity but have previously indicated that they wish to receive artificial hydration and nutrition should have their wishes respected. This proposal from the Worcestershire division was endorsed at the annual meeting by 59 votes to 56.
Dr Anthony Cole, a consultant paediatrician at the Worcester Royal Infirmary, said that guidelines from the BMA about the withdrawal of hydration and nutrition had made some doctors uncomfortable and he had told his family that he did not wish to die from lack of food or water.
The Mental Capacity Bill would enable people to spell out what medical care they would want if they became seriously ill and were unable to make their own decisions (26 June, p 1516).
The bill would give legal force to an advance refusal for treatment but not to a request for treatment, although it did specify that patients?wishes should be taken into account. Dr Cole said that he had made a declaration about the appropriate treatment that he would wish to receive and that the motion said that such requests should he respected. The proposal would not be binding on the profession, he said.
Speaking against the motion, Dr Lewis Morrison, a geriatrician from Lothian, said that it implied that the decision to treat would be in the hands of the patient regardless of the opinion of the responsible clinician. "The best clinical decisions," he said, "are made by clinicians and their teams in discussion with patients and their families or carers to achieve consensus."
But sometimes geriatricians had to take difficult decisions that were not in accordance with others?wishes. For some patients at the end of life artificial hydration and nutrition would not change the prognosis or improve the quality of life but would increase distress. Rejecting the decision was not condoning euthanasia by the back door but would leave difficult decisions in the hands of the people best able to make them.(BMJ Linda Beecham)
Dr Anthony Cole, a consultant paediatrician at the Worcester Royal Infirmary, said that guidelines from the BMA about the withdrawal of hydration and nutrition had made some doctors uncomfortable and he had told his family that he did not wish to die from lack of food or water.
The Mental Capacity Bill would enable people to spell out what medical care they would want if they became seriously ill and were unable to make their own decisions (26 June, p 1516).
The bill would give legal force to an advance refusal for treatment but not to a request for treatment, although it did specify that patients?wishes should be taken into account. Dr Cole said that he had made a declaration about the appropriate treatment that he would wish to receive and that the motion said that such requests should he respected. The proposal would not be binding on the profession, he said.
Speaking against the motion, Dr Lewis Morrison, a geriatrician from Lothian, said that it implied that the decision to treat would be in the hands of the patient regardless of the opinion of the responsible clinician. "The best clinical decisions," he said, "are made by clinicians and their teams in discussion with patients and their families or carers to achieve consensus."
But sometimes geriatricians had to take difficult decisions that were not in accordance with others?wishes. For some patients at the end of life artificial hydration and nutrition would not change the prognosis or improve the quality of life but would increase distress. Rejecting the decision was not condoning euthanasia by the back door but would leave difficult decisions in the hands of the people best able to make them.(BMJ Linda Beecham)