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