Remembrance of Conversations Past: Oral Advance Statements About Medical Treatment
BMJ (British Medical Journal). 1995 Jun 24; 310(6995): 1663-1665.
Polls show increasing public interest in advance statements or directives about medical treatment ("living wills") but that few people, apart from Jehovah's Witnesses, carry such documents. Patients' firm, witnessed oral decisions are often sufficient to aid clinical decision making but should still be recorded in medical notes. Without documentation, dilemmas arise when others claim to know patients' views on the basis of past unrecorded conversations and demand withdrawal of treatment when patients are not terminally ill and cannot speak for themselves. Legal and ethical considerations oblige doctors to act in the best interests of an incapacitated patient; these considerations are now formally defined in draft legislation as including consideration of the patient's past wishes. The practicalities of ascertaining the strength and validity of such wishes from conversations reported second hand are complex. The paucity of legal and ethical guidance on reported oral advance statements makes debate imperative and renders the alternative of having designated surrogate decision makers increasingly attractive.
Advance Directives; Allowing to Die; Autonomy; Communication; Consent; Decision Making; Doctors; Family Members; Jehovah's Witnesses; Legal Aspects; Legislation; Living Wills; Methods; Organizations; Patients; Physicians; Professional Organizations; Resuscitation; Standards; Terminally Ill; Treatment Refusal; Uncertainty; Wills;
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Feenan, Dermot (1995-07-12)The BMA recently produced comprehensive professional guidance on advance statements and medical treatment, in the form of a Code of Practice and explanatory notes. However, some of the guidance is problematic. This article ...