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Ethical aspects of the case scenario
  1. Rob George, Senior Lecturer
  1. Consultant in Palliative Medicine and Senior Lecturer in Biomedical Ethics, University College London

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The story of Sam’s death demonstrates the effectiveness of teamwork and how end-of-life care can be managed in acute hospitals. The central theme concerns how clinicians should respond to patients whose mental capacity to make decisions is changeable and whose actions suggest that they wish treatment to stop. The guiding principle behind the team’s actions in the scenario described was a concern to act in Sam’s best interests. However, his best interests and their assessment changed through his hospital stay. At the beginning, since Sam was incapable of expressing his wishes, the team acted on the presumption that Sam wanted to live. This is termed ‘presumption in favour of life’. The presumption appeared to be in Sam’s best interest.

However, when Sam regained consciousness, his actions suggested that the presumption was incorrect. He expressed his autonomy in the only way that he could — by removing his nasogastric (NG) and intravenous (IV) tubes. It is on this principle of autonomy that I wish to devote a few words, particularly because …

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