MinervaBMJ 2010; 340 doi: https://doi.org/10.1136/bmj.c1285 (Published 09 March 2010) Cite this as: BMJ 2010;340:c1285
All rapid responses
In March 2010 Minerva cited an article in Chest regarding a mneumonic
developed to help doctors in the USA to help access a patient's capacity
make a an appropriate decision in an emergency 1 . Caresse, Chow and
Colleagues at the John Hopkins Institute developed the bioethics memory
to help doctors to recall the criteria and help them document their
. They described the acronym CURVES, which stands for Choose and
Communicate, Understand, Reason, Value, Emergency and Surrogate. As part
of training Doctors and medical students memorize mnemonic devices to
help recall information quickly, and applying this one will help them
determine whether a patient is able to make decisions in emergency
situations fraught with stress and uncertainty. However in the UK, the
Capacity (England and Wales) Act 2005 and Adults with Incapacity
Act 2000 there are differences in making decisions about a person’s
to the USA. We have developed a bioethics memory aid for all health care
professionals in England, Scotland and Wales for use in patients aged 18
over in an emergency situation. In Northern Ireland there is no legal
to make a consent decision on behalf of someone else. The process for
making best interest decisions in serious medical conditions in adult
is well described in a flowchart by Regnard 3 but this memory aid may not
immediately available to the clinicians when they need it. We hope that
health care staff including ambulance staff, nurses, doctors, social
midwives will find this useful.
C Communicate. Can the person communicate their decision?
U Understand. Can they understand the information you giving them?
R Retain. Can they retain the information given to them?
B Balance, Can they balance or use the information?
B Best Interest. If no capacity can you make a best interest
AD Advanced decision. Is there an Advanced Decision to refuse treatment?
L Lasting power of attorney. Has Lasting Power of Attorney (PW-LPA) been
I Independent Mental Capacity Advocate. Is the person without anyone to
be consulted about their best interest. In an emergency involve an
independent Mental Capacity Advocate
P Proxy. If unresolved conflicts consider local ethics committee or the
Court of Protection appointed deputy
Dr Matt Hoghton, GP, RCGP Circ Learning Disability Champion, NHS
Somerset Clinical Governance Lead
Dr Stephanie Chadwick, GP, Bristol University Ethics Lecturer
1. BMJ 2010;340:c1285
2. Chest 2010;137:421-7
3. Regnard C. From: Regnard, Dean & Hockley; A guide to Symptom
Palliative Care 6th ed, Oxford: Radcliffe Publishing
Competing interests: No competing interests