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Ethics and the law: delegating decisions to another person
  1. Rob George, Consultant in Palliative Medicine and Senior Lecturer in Biomedical Ethics and
  2. Bridgit Dimond
  1. University College London.
  2. Emeritus Professor, University of Glamorgan

Abstract

Many nurses will be familiar with the situation in which an over-protective or ‘interfering’ relative disrupts communication between the medical team and the patient, by speaking on behalf of the patient. The second case in our short series on mental capacity follows on from Jane’s story, covered in the last issue (George and Dimond, 2007). You will recall that Jane was in the last few days of her life and was incapable of making decisions for herself. In that case, the clinicians encountered a difference of opinion between her biological family and her declared next of kin as to what was in Jane’s best interest. The Case scenario in this issue (see box) describes a patient who is quite capable of making her own decisions, but is rendering herself incapable by electing to defer to her mother and extended family, allowing them to make critical treatment decisions. A serious problem has arisen because the family is refusing life-saving treatment on behalf of the patient. The patient appears passively to be colluding with her family by not responding to the medical team directly. It is the medical opinion that treatment is in the patient’s best interest. This article will examine the legal and ethical issues of the scenario, discussing methods by which this type of situation can be managed.

  • Artifical nutrition and hydration
  • Best interest
  • Mental capacity
  • Refusal of (life-saving) treatment

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