I am fascinated by the exchange between Jolley and Oliver
I find the exchange of responses between David Jolley and David Oliver fascinating - because I completely believe Oliver when he writes 'I agree entirely with Jolley'. The ability of two people (and I'm not thinking of Jolley and Oliver specifically here - the point is wider) who apparently agree with each other to engage in 'heated dispute' is peculiar, when you think about it. There is plenty of scope for heated argument when people hold genuinely different positions, but it is perplexing that the same thing can happen when people apparently in reality share the same position.
When I post on Nursing Times, I frequently seem to be 'attacked' for things which in my opinion I did not write. That still 'surprises' me, although I am aware that I 'write differently' from the way that many nurses express themselves: so do some of these misunderstandings arise from differing interpretations of particular words and phrases ? And do some problems arise because readers place differing 'emphasis' on particular words ?
Jolley points at Oliver's ‘Many patients are technically eligible for continuing care but don’t currently receive it’ and highlights that word 'technically'. I am invariably riled when I read, in the context of end-of-life guidance, 'technically treatment without consent is an assault' - because I see that as downplaying the importance of 'the discussions around consent' compared to 'clinical objectives'. I am equally 'riled' when I come across statements such as 'giving patients a sense of control': I want patients to be given control, not 'a sense of control' [and I never come across 'giving clinicians a sense of control'].
I used to exchange e-mails with Tessa Ing when she was head of an EoL unit at the Department of Health, and after a few weeks we suddenly had a falling out: with Tessa suggesting that I wasn't supporting ongoing treatment for terminal patients, and in return I felt that Tessa was arguing in support of pointless interventions. It turned out that this arose from the phrase 'palliative treatment'. At the time, I had not read all of this 'palliative care literature' which clinicians, and Tessa, had read. My use of 'palliative care' amounted to care during what clinicians refer to as 'the dying phase', or 'the final days and weeks of life' - but Tessa was using 'palliative' over a much longer timescale, of months or years.
I did have a genuine argument with Tessa - it amounted to my insistence that because section 4(9) of the Mental Capacity Act is a legal duty, which applies to family carers as well as to clinicians, it logically follows that the claim 'that normal family carers cannot legitimately make best-interests decisions for the provision or withholding of medical treatment' is legally incorrect. We disputed this point 'so ferociously' that eventually we mutually agreed to try and stay away from it (which is effectively impossible for me - my entire analysis of the MCA hinges on the difference between the duty imposed by section 4(9) and the power given by section 6(6)).
But there are plenty of things to argue about, where people really do hold different positions - it is 'strange' that people can argue so heatedly and passionately, when they share the same position !
Rapid Response:
I am fascinated by the exchange between Jolley and Oliver
I find the exchange of responses between David Jolley and David Oliver fascinating - because I completely believe Oliver when he writes 'I agree entirely with Jolley'. The ability of two people (and I'm not thinking of Jolley and Oliver specifically here - the point is wider) who apparently agree with each other to engage in 'heated dispute' is peculiar, when you think about it. There is plenty of scope for heated argument when people hold genuinely different positions, but it is perplexing that the same thing can happen when people apparently in reality share the same position.
When I post on Nursing Times, I frequently seem to be 'attacked' for things which in my opinion I did not write. That still 'surprises' me, although I am aware that I 'write differently' from the way that many nurses express themselves: so do some of these misunderstandings arise from differing interpretations of particular words and phrases ? And do some problems arise because readers place differing 'emphasis' on particular words ?
Jolley points at Oliver's ‘Many patients are technically eligible for continuing care but don’t currently receive it’ and highlights that word 'technically'. I am invariably riled when I read, in the context of end-of-life guidance, 'technically treatment without consent is an assault' - because I see that as downplaying the importance of 'the discussions around consent' compared to 'clinical objectives'. I am equally 'riled' when I come across statements such as 'giving patients a sense of control': I want patients to be given control, not 'a sense of control' [and I never come across 'giving clinicians a sense of control'].
I used to exchange e-mails with Tessa Ing when she was head of an EoL unit at the Department of Health, and after a few weeks we suddenly had a falling out: with Tessa suggesting that I wasn't supporting ongoing treatment for terminal patients, and in return I felt that Tessa was arguing in support of pointless interventions. It turned out that this arose from the phrase 'palliative treatment'. At the time, I had not read all of this 'palliative care literature' which clinicians, and Tessa, had read. My use of 'palliative care' amounted to care during what clinicians refer to as 'the dying phase', or 'the final days and weeks of life' - but Tessa was using 'palliative' over a much longer timescale, of months or years.
I did have a genuine argument with Tessa - it amounted to my insistence that because section 4(9) of the Mental Capacity Act is a legal duty, which applies to family carers as well as to clinicians, it logically follows that the claim 'that normal family carers cannot legitimately make best-interests decisions for the provision or withholding of medical treatment' is legally incorrect. We disputed this point 'so ferociously' that eventually we mutually agreed to try and stay away from it (which is effectively impossible for me - my entire analysis of the MCA hinges on the difference between the duty imposed by section 4(9) and the power given by section 6(6)).
But there are plenty of things to argue about, where people really do hold different positions - it is 'strange' that people can argue so heatedly and passionately, when they share the same position !
Competing interests: No competing interests