Advanced Decisions vs Letters of Wishes/Intentions:Need to be Careful
This helpful analysis [1],among other things, highlights the importance of differentiating between a proper advance decision(per Mental Capacity Act 2005) and a letter of wishes/intentions as in Miss Wooltorton's case.It was also reported that Miss Wooltorton was allowed to die "because doctors feared saving her would be assault"[2].As I have not had sight of the relevant coroner's report, it is difficult to say whether or not a senior psychiatrist was consulted before giving into the written wishes of Miss Wooltorton. Further, as amplified by the authors[1], it is crucial that any assessment of mental capacity is a very thorough one, and must include judging the patient's ability to 'use or weigh' the relevant information. This case also illustrates, considerations under the Mental Health Act 1983(as amended) must not be forgotten even if one has written wishes as to medical management following a suicidal attempt. I hope, lessons will be learned from this case.
References
[1]Analysis:
Mentally disordered or lacking capacity? Lessons for management of serious deliberate self harm.
Anthony S David, Matthew Hotopf, Paul Moran, Gareth Owen, George Szmukler, and Genevra Richardson
BMJ 2010 341:c4489; doi:10.1136/bmj.c4489
Rapid Response:
Advanced Decisions vs Letters of Wishes/Intentions:Need to be Careful
This helpful analysis [1],among other things, highlights the importance of differentiating between a proper advance decision(per Mental Capacity Act 2005) and a letter of wishes/intentions as in Miss Wooltorton's case.It was also reported that Miss Wooltorton was allowed to die "because doctors feared saving her would be assault"[2].As I have not had sight of the relevant coroner's report, it is difficult to say whether or not a senior psychiatrist was consulted before giving into the written wishes of Miss Wooltorton. Further, as amplified by the authors[1], it is crucial that any assessment of mental capacity is a very thorough one, and must include judging the patient's ability to 'use or weigh' the relevant information. This case also illustrates, considerations under the Mental Health Act 1983(as amended) must not be forgotten even if one has written wishes as to medical management following a suicidal attempt. I hope, lessons will be learned from this case.
References
[1]Analysis:
Mentally disordered or lacking capacity? Lessons for management of serious deliberate self harm.
Anthony S David, Matthew Hotopf, Paul Moran, Gareth Owen, George Szmukler, and Genevra Richardson
BMJ 2010 341:c4489; doi:10.1136/bmj.c4489
[2]http://www.telegraph.co.uk/health/6248646/Suicide-woman-allowed-to-die-b...(accessed-20 September 2010)
Competing interests: No competing interests