New guidelines on withdrawing treatment welcomed by learning difficulties charity

Learning difficulties charity Mencap has welcomed the General
Medical Council’s new guidelines for doctors on withholding
or withdrawing a patient’s treatment, writes
Clare Jerrom.

The draft guidelines, which the GMC hope will be approved later
this month, “rightly explore some of the difficult considerations
when making often distressing decisions on withholding medical
treatment,” Mencap says.

But head of campaigns Richard Kramer has warned that the
guidelines need to be accompanied by new legislation, if the rights
of disabled people are to be safeguarded.

“Under the current legal framework it is unclear who has the
right to make day-to-day decisions about healthcare or welfare on
behalf of people who lack the capacity to make decisions
independently,” Kramer said.

“Mencap is campaigning for new legislation on mental capacity to
ensure that families can challenge the decisions of doctors and
that severely disabled adults receive appropriate care, medical
treatment and protection,” he added.

The GMC’s draft guidelines claim that where adult patients
lack capacity to decide for themselves, the doctor must take
account of their wishes when making an assessment of the benefits,
burdens, risks and acceptability of proposed treatment .

But where a patient’s wishes are not known it is the
doctor’s responsibility to decide what is in the
patient’s best interests. It says this cannot be done without
information about the patient, and people close to the patient are
“best placed to know”.

The guidelines also suggest that when a health team, doctor and
those close to the patient reach different conclusions about the
patient “it is important to take time to try to reach a consensus
about treatment and it may be appropriate to seek a second opinion,
or other independent or informal review”.

Where there are doubts about a patient’s capacity to make
a decision, the guidelines suggest a thorough assessment consulting
relevant professional guidelines, where appropriate a second
opinion and if there is still doubt, legal advice must be sought,
which may include asking a court to determine capacity.