ABSTRACT
In the UK, restraining medical patients in order to provide care is widely considered to be outmoded and difficult to justify. The prevailing clinical intuition that restraining patients is generally wrong (even when restraint is essential in order to provide artificial nutrition and hydration) has prompted us to develop a policy that is compatible with common law, the Mental Capacity Act 2005 and the Human Rights Act 1998. The nature and scope of the problem are illustrated with clinical cases. These, in turn, serve to demonstrate the tension that arises between article 2, article 3 and article 8 rights, when incompetent patients are restrained in order to feed.
Subject(s)
Patient Care , Restraint, Physical/legislation & jurisprudence , Health Policy , Human Rights , Humans , Mental Competency , Parenteral Nutrition , State Medicine , United KingdomABSTRACT
Non-voluntary passive euthanasia, the commonest form of euthanasia, is seldom mentioned in the UK. This article illustrates how the legal reasoning in Airedale NHS Trust v Bland contributed towards this conceptual deletion. By upholding the impermissibility of euthanasia, whilst at the same time permitting 'euthanasia' under the guise of 'withdrawing futile treatment', it is argued that the court (logically) allowed (withdrawing futile treatment and euthanasia). The Bland reasoning was incorporated into professional guidance, which extended the court's ruling to encompass patients who, unlike Anthony Bland, were sentient. But since the lawfulness of (withdrawing futile treatment and euthanasia) hinges on the futility of treatment, and since the guidance provides advice about withdrawing treatment from patients who differ from those considered in court, the lawfulness of such 'treatment decisions' is unclear. Legislation is proposed in order to redress the ambiguity that arose when moral decisions about 'euthanasia' were translated into medical decisions about 'treatment'.
Subject(s)
Euthanasia, Passive/legislation & jurisprudence , Human Rights/legislation & jurisprudence , Medical Futility/legislation & jurisprudence , Advance Directives/legislation & jurisprudence , Decision Making/ethics , Humans , Life Support Care/legislation & jurisprudence , Life Support Care/standards , Mental Competency/legislation & jurisprudence , Morals , Quality of Life , Social Values , Terminology as Topic , United Kingdom , Value of LifeSubject(s)
Cardiopulmonary Resuscitation , Decision Making , Judgment , Proxy , Aged , Aged, 80 and over , Family , Female , Humans , Male , Physician's Role , Quality of LifeABSTRACT
We present a patient with a background of psychiatric illness who was admitted to hospital with neurological symptoms and signs. Although the organic cause of the neurological disorder was extremely uncommon and hence not readily diagnosed, the signs clearly did not accord with the preexisting psychiatric diagnoses. Nevertheless, several clinicians attributed the cause of the disorder to mental illness, or drug side-effects. It is possible that patients suffering from mental illness may be assessed differently, perhaps due to prejudgement by clinicians.
