Assessment of Best Interests
Alice is 45 years old, and following viral encephalitis she has been left with severe neurological impairment with no prospect of improvement. She cannot move or speak and is entirely dependent on others for care. She is receiving clinically assisted nutrition and hydration. Alice was close to her father and sister and long-term partner. She does not have children. Her family considers that she would not wish to carry on living in this condition and that feeding should be withheld so she can die peacefully and with dignity.
Paul is 42. He has a severe learning disability and end-stage renal failure secondary to diabetes. Unless he receives an organ transplant, his life expectancy is significantly reduced. He requires dialysis three times a week. He has a needle phobia and due to his learning disabilities becomes physically aggressive and resists attempts by doctors to examine or treat him. In order to carry out dialysis, he would require sedation by general anesthetic, which carries inherent risks. His understanding of the situation is very limited.
Susan is 55 years old and has a severe learning disability. She has localized cancer of the uterus and her gynecologist considers that without a hysterectomy the tumor will likely metastasize and lead ultimately to her death.
- What factors should be considered in assessing the ‘best interests’ of an incompetent adult patient?
- Who makes the decision about the patient’s best interests?
- What if the clinical team and the patient’s relatives disagree about what treatment is in the patient’s best interests?
- Is it always in the patient’s best in
Apply Theory (Specific Professional Healthcare Competencies + Clinical Medical Ethical Principles) to Practice in order to provide Optimal Patient-Centered Care (OPCC)
Clinical Ethics and Law, Second edition. Carolyn Johnston, Penelope Bradbury, Series editor: Janice Ryme
