As I have been reporting these past months, there have been quite a few recent British cases (many now in the courts) involving patients placed on the Liverpool Care Pathway without relatives' knowledge.
On Monday, UK Health Secretary Jeremy Hunt will announce the new obligation on doctors as part of a raft of changes to the NHS constitution. Under the reforms, being put out for consultation on Monday, health trusts that fail to involve patients and families in decisions could be sued while doctors who ignore their wishes face being struck off.
It appears that the new guidance will not change British clinicians' substantive right to refuse inappropriate interventions. It will just change the transparency with which that right is exercised. We will soon see this same issue bubble to the surface in the United States. First, even in jurisdictions in which clinicians may have the right to stop life-sustaining treatment,they have been successfully sued for infliction of emotional distress for doing so in an insensitive or secretive manner.
Second, an increasingly popular mechanism for avoiding or preventing futility conflicts is improving EOL communication. Unfortunately, this is often implemented such that potentially effective (though "hopeless") options are simply never presented to the surrogate. This is often effective at avoiding conflict, because the surrogate never elects to pursue options that she does not know exists. But this approach is also paternalistic. It merely relocates the "clinician power versus patient autonomy" conflict - from one concerning the treatment itself to one concerning informed consent regarding that treatment.
0 nhận xét:
Đăng nhận xét