Withholding and Withdrawing Life-prolonging Medical Treatment

Medical Ethics Committee viii
Editorial board for the third edition x
Acknowledgements for the third edition xi
Introduction xii
Part 1: How to use this guidance 1
1. Scope, purpose and structure of this guidance 1
Part 2: Defining key terms and concepts 3
2. The primary goal of medicine 3
3. Life-prolonging treatment 5
4. Capacity and incapacity 5
5. Duty of care 6
6. Quality of life 8
7. Benefit 10
8. Harm 11
9. Best interests 12
10. Futility 14
11. Basic care 15
12. Artificial nutrition and hydration 15
13. Oral nutrition and hydration 17
14. Foresight and intention 18
15. Withholding or withdrawing treatment 19
16. Conscientious objection 20
17. Resource management 21
Part 3: Legal and ethical considerations that apply to alldecisions to withhold or withdraw treatment 23
18. Human Rights Act 1998 23
19. Fairness and non-discrimination 28
20. Communication 31
21. Confidentiality 32
22. Legal review 34
Part 4: Medical considerations that apply to all decisions towithhold or withdraw treatment 36
23. Medical assessment 36
24. Medical decision making 39
Part 5: Decision making by adults with capacity 43
25. The law 43
26. Communication and information 47
Part 6: Decision making on behalf of adults who lack capacity50
England and Wales 50
27. Patients with a Lasting Power of Attorney (LPA) 50
28. Patients with an advance decision about medical treatment52
29. Patients without a Lasting Power of Attorney or advancedecision 57
30. Patients in persistent vegetative state (pvs) 61 Scotland62
31. Patients with a welfare power of attorney or welfareguardian 62
32. Patients with an advance decision about medical treatment64
33. Patients without a welfare power of attorney or advancedecision 67
34. Patients in persistent vegetative state (pvs) 68
Northern Ireland 69
35. Patients with an advance decision about medical treatment69
36. Patients without an advance decision about medical treatment69
37. Patients in persistent vegetative state (pvs) 71
All UK jurisdictions 72
38. Capacity and incapacity 72
39. Communication and information 73
40. Assessing best interests 77
41. Dealing with disagreement 80
Part 7: Decision making by young people with capacity83
42. The law in England,Wales and Northern Ireland 83
43. The law in Scotland 88
44. Assessing capacity 91
45. Communicating with young people 92
46. Dealing with disagreement 95
Part 8: Decision making for children and young people wholack capacity 96
47. The law 96
48. Duties owed to babies and children 102
49. Communicating with parents 104
50. Assessing best interests 106
51. Dealing with disagreement 108
Part 9: Once a decision has been reached 109
52. Keeping others informed 109
53. Recording and reviewing the decision 109
54. Providing support 111
55. Respecting patients' wishes after death 113
Appendix 1 Useful addresses 114
References 118
Index 123