Article Text

Ethics and the law: when an advance care plan is overruled
  1. Rob George and
  2. Bridgit Dimond
  1. Ethical aspects: Rob George, Consultant in Palliative Medicine, Guy’s and St Thomas’ NHS Foundation Trust. Legal aspects: Bridgit Dimond, Emeritus Professor, University of Glamorgan


Advance care plans must be as clear as possible with full consideration given to the likely process of the illness, possible complications, comorbidities and what treatments might become necessary. The Case scenario (see box) describes a situation in which a woman with advanced disease made an advance care plan stating that she did not want to spend her final days in hospital and did not want to be resuscitated. However, these wishes were overruled. The article examines how best to honour a patient’s wishes when the main carer feels unable to cope with sudden deterioration and when a health professional fears litigation if treatment and resuscitation are not carried out. It discusses the problems and difficulties associated with advance care planning and predicting the future and highlights the issue of individual autonomy versus relational autonomy. The underlying message is that the duty of care of health professionals is not to act in their own best interests (through fear of litigation, etc.) but the best interests of their patients. The article will first examine the legal aspects of the case before examining the ethical implications. Conflicts of interest: none

  • Advance care planning
  • Advance refusal of treatment
  • Autonomy
  • End-of-life management

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