Who decides whether the patient is mentally incapacitated?

BMJ 1998;317:280 ( 25 July )

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Who decides whether the patient is mentally incapacitated?

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EDITOR $---$ Gadd highlighted that patients have the right under common law to make advanced refusals, while they have the capacityto do so, of treatments when incapacitated.¹ However, the caselaws on which this right is based also illustrate the complexitiesin judging the patient's mental capacity.

In Re T the Court of Appeal held that an advanced written refusal of blood transfusion by a mentally normal pregnant womanrequiring a caesarean section was invalid.² This was becauseshe might have been influenced by her mother, who was a Jehovah'sWitness, and because it was unclear whether she had intended torefuse all blood transfusions or only those that were not necessaryto keep her alive. This case was in sharp contrast to that ofRe C, in which a chronic schizophrenic in Broadmoor Hospital withgross grandiose delusions was held to be mentally competent togive advanced refusal . . . [Full text of this article]

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Changing the law on decision making for mentally incapacitated adults: Elaine Gadd
BMJ 1998 316: 90. [Extract] [Full Text]

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