Withholding and Withdrawing Life-Prolonging

This book is the authoritative statement from the BMA Medical Ethics Department on one of the most fundamental and contentious issues for health care professionals, of when to withhold or withdraw life-prolonging treatment. It is used by doctors and nurses throughout the United Kingdom who care for the dying, as well as lawyers and others in the health professions seeking guidance on this controversial issue. Use of summary boxes with key recommendations and discussions of real cases interspersed through the text will make the new edition even more practical and easy to use. Important new features for the third edition: - Inclusion of the provisions of the Mental Capacity Act, which comes into force in April 2007 - Guidance on the appointment of welfare attorneys to make health care decisions once capacity is lost. - The latest policy on advance directives - Update on the impact of the Human Rights Act on such decisions - Discussion of recent cases, including Burke, baby MB, and Wyatt This book is written by medical ethics professionals in consultation with the appropriate medical and legal experts and in agreement with the General Medical Council's guidelines. It is regarded as the most authoritative advice on this subject in the country. The new edition will bring the information fully up to date from both the legal and the ethical perspective. .

This book is written and edited by members of the Medical Ethics Department of the British Medical Association with advice from the BMA’s Medical Ethics Committee

Medical Ethics Committee	p. viii
Editorial board for the third edition	p. x
Acknowledgements for the third edition	p. xi
Introduction	p. xii
How to use this guidance	p. 1
Scope, purpose and structure of this guidance	p. 1
Defining key terms and concepts	p. 3
The primary goal of medicine	p. 3
Life-prolonging treatment	p. 5
Capacity and incapacity	p. 5
Duty of care	p. 6
Quality of life	p. 8
Benefit	p. 10
Harm	p. 11
Best interests	p. 12
Futility	p. 14
Basic care	p. 15
Artificial nutrition and hydration	p. 15
Oral nutrition and hydration	p. 17
Foresight and intention	p. 18
Withholding or withdrawing treatment	p. 19
Conscientious objection	p. 20
Resource management	p. 21
Legal and ethical considerations that apply to all decisions to withhold or withdraw treatment	p. 23
Human Rights Act 1998	p. 23
Fairness and non-discrimination	p. 28
Communication	p. 31
Confidentiality	p. 32
Legal review	p. 34
Medical considerations that apply to all decisions to withhold or withdraw treatment	p. 36
Medical assessment	p. 36
Medical decision making	p. 39
Decision making by adults with capacity	p. 43
The law	p. 43
Communication and information	p. 47
Decision making on behalf of adults who lack capacity	p. 50
England and Wales	p. 50
Patients with a Lasting Power of Attorney (LPA)	p. 50
Patients with an advance decision about medical treatment	p. 52
Patients without a Lasting Power of Attorney or advance decision	p. 57
Patients in persistent vegetative state (pvs)	p. 61
Scotland	p. 62
Patients with a welfare power of attorney or welfare guardian	p. 62
Patients with an advance decision about medical treatment	p. 64
Patients without a welfare power of attorney or advance decision	p. 67
Patients in persistent vegetative state (pvs)	p. 68
Northern Ireland	p. 69
Patients with an advance decision about medical treatment	p. 69
Patients without an advance decision about medical treatment	p. 69
Patients in persistent vegetative state (pvs)	p. 71
All UK jurisdictions	p. 72
Capacity and incapacity	p. 72
Communication and information	p. 73
Assessing best interests	p. 77
Dealing with disagreement	p. 80
Decision making by young people with capacity	p. 83
The law in England, Wales and Northern Ireland	p. 83
The law in Scotland	p. 88
Assessing capacity	p. 91
Communicating with young people	p. 92
Dealing with disagreement	p. 95
Decision making for children and young people who lack capacity	p. 96
The law	p. 96
Duties owed to babies and children	p. 102
Communicating with parents	p. 104
Assessing best interests	p. 106
Dealing with disagreement	p. 108
Once a decision has been reached	p. 109
Keeping others informed	p. 109
Recording and reviewing the decision	p. 109
Providing support	p. 111
Respecting patients' wishes after death	p. 113
Useful addresses	p. 114
References	p. 118
Index	p. 123
Table of Contents provided by Ingram. All Rights Reserved.

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Withholding and Withdrawing Life-Prolonging Medical Treatment : Guidance for Decision Making

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