Analysis Ethical debate

Are advance directives legally binding or simply the starting point for discussion on patients’ best interests? Ethical view

BMJ 2009; 339 doi: http://dx.doi.org/10.1136/bmj.b4695 (Published 26 November 2009) Cite this as: BMJ 2009;339:b4695
  1. Sheila A M McLean, co-director
  1. 1Centre for Applied Ethics and Legal Philosophy, University of Glasgow, Glasgow G12 8GE
  1. s.mclean{at}lbss.gla.ac.uk

    Following advance directives in emergencies throws up some complicated problems, as Stephen Bonner and colleagues found (doi:10.1136/bmj.b4667). We asked an emergency doctor (doi:10.1136/bmj.b4697), a medical defence adviser (doi:10.1136/bmj.b4693), and an ethicist what they would do in the circumstances

    Confronted with a legally valid advance directive, medical staff in England and Wales are essentially bound to follow its terms if they are applicable to the circumstances since the passing of the Mental Capacity Act 2005. The act enshrines the concept of autonomy in statute, allowing individuals to choose to avoid a particular treatment that they would, for whatever reason, find unacceptable. In Scotland, there is no statute that gives legal effect to advance directives, but there is a general view that they should be followed. In this case, there is no evidence that the patient was not competent …

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