1. 1 Ethical Issues for Neurological Patients Dr Lynne Russon Consultant in Palliative Medicine. Bradford 2 nd May 07

2. 2 Four principles of medical ethics 1. Beneficence. 2. Non maleficence. 3. Autonomy. 4. Justice

3. 3 Neurological Patients Informed consent Assessing capacity Withdrawing and withholding treatment

4. 4 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)

5. 5 Adequate time for deliberation not likely if emergency proceedure Adequate information for each individual Patient must be considered competent.

6. 6 BMA’s 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.

7. 7 Competence cont. Make a choice free from undue pressure. Retain the information long enough to make an effective decision.

8. 8 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.

9. 9 Mental Capacity Act cont. Lasting powers of attorney (Enduring power of attorney) Court appointed deputies New court of protection Advanced decisions to refuse treatment

10. 10 Withdrawing and WitholdingTreatment Act vs Omission James Rachel’s argument

11. 11 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.’

12. 12 WITHHOLDING AND WITHDRAWING TREATMENT Basic Care Life prolonging treatment PEGs? Benefits and burdens equations Consider in terms of the four principles

13. 13 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

14. 14 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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