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ss triple helix - Christmas 2008,  Advance decisions to refuse treatment

Advance decisions to refuse treatment

Peter Gibson is a consultant physician doing general medicine in Manchester. He was unhappy with a News Review in the last edition.

I enjoyed reading many of the well balanced articles in the Summer 2008 Triple Helix. However, I was very disappointed by the article [1] about 'Advance decisions to refuse treatment' which was (in my view) very unbalanced.

Sometimes, we have patients with multiple co-morbidities and limited life expectancy who lack mental capacity to make decisions about treatment at the time of their admission to hospital. It would be very helpful for us to know to what extent they want medical interventions to prolong their life. At present, I suspect that we give some of these patients a lot of invasive, unpleasant, painful medical treatment, when what they would really like is good quality palliative care.

The legislation is not perfect. However, it has been carefully drafted and deals with most of the concerns raised in the article.

Andrew Fergusson replies:

Peter and I have had a constructive correspondence about this. For the record, although he practises in the Manchester area, he had no personal involvement in the Salford scheme which promotes ADRTs.

I totally agree that 'we give some of these patients a lot of invasive, unpleasant, painful medical treatment, when what they would really like is good quality palliative care', and I agree that prior knowledge of patients' general wishes can be very helpful should they become incapacitated and unable to express them.

The News Review piece was stimulated by the aggressive promotion of ADRTs (and an activist in the euthanasia campaign group Dignity in Dying was centrally involved in the Salford initiative), but 'we stand by our story'. While I agree with Pater Gibson that we must recognize the inevitability and often the rightness of natural death, we must also be vigilant about the possibility of unnatural deaths.

Reference:

[1] Fergusson A

Triple Helix 2008, Summer: 5

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