Thứ Năm, 12 tháng 12, 2013

Prolonged Disorders of Consciousness – New RCP Guidanc



Yesterday, the Royal College of Physicians launched new guidelines on the diagnosis and management of people with prolonged disorders of consciousness (PDOC), a term covering patients remaining in a coma, vegetative state (VS), and minimally conscious state (MCS) after a brain injury.  Of particular interest are chapters 4 and 5.



Section 4: Ethical and medico-legal issues




  • Introduction 


    • Ethical principles 


  • The Mental Capacity Act 2005 


    • Mental capacity in patients with PDOC 


  • Provisions within the Act to support decision-making for patents who lack capacity 


    • Health and Welfare Lasting Power of Attorney 

    • Court-appointed Welfare Deputy 

    • Independent Mental Capacity Advocate 


  • Process to establish ‘best interests’ 


    • The role of the healthcare team 

    • The role of the family 


  • A summary of key roles in decision-making 

  • Practical arrangements for best interests decision-making 

  • Ethical considerations – the subjective challenges 


    • What is it like to be in VS or MCS? 

    • The evidence on pain 

    • Decisions about life-sustaining treatments in PDOC


  • Applications to the Court of Protection 


    • Applications for withdrawal of CANH 


  • Other factors affecting referral to the Court of Protection 


    • Individual planning 

    • Clinicians and conscientious objection





Section 5: End-of-life issues




  • End-of-life planning 


    • The family role in planning end-of-life care


  • Decisions about life-sustaining treatment and ceiling of care 


    • ‘Do Not Attempt Cardiopulmonary Resuscitation’ (DNACPR) decisions

    • Ongoing DNACPR decisions 


  • Withdrawing other life-sustaining treatments 


    • Permanent vegetative state

    • Permanent minimally conscious state 


  • Practical management of end-of-life care for patients with PDOC


    • Challenges for end-of-life care and place of death

    • End-of-life care following withdrawal of CANH 

    • Certification of death 

    • Suitable setting for end-of-life care 






0 nhận xét:

Đăng nhận xét