#10042 - Refusal Of Treatment - Medical Law and Ethics

REFUSAL OF TREATMENT

LAW

1. Airedale NHS Trust v Bland – competent person can refuse treatment even if this means they’ll die

2. St George’s v S – woman entitled to refuse treatment even though meant death to her unborn child too

OPENING POINTS

1. Law recognises patient’s right to refuse treatment, but questions about capacity have been used as a means to subvert this right

ETHICAL POINTS

1. Herring – is refusing necessary medical treatment tantamount to suicide – link to doctrine of double effect

2. David Shaw – current law is based on an illogical distinction: euthanasia is not permitted but patients entitled to reject life-support

3. Gorsuch – provides example of a patient who refuses blood transfusion for religious reasons

PATIENTS SHOULDN’T BE ALLOWED TO REFUSE TREATMENT

1. Mason and Laurie – say how St George’s emphasizes how law should be able to override competent patients refusal of medical treatment, as otherwise there is too much heed to cult of self-determination’

USE OF DISABILITY TO GET AROUND IT

1. St George’s v A (CA) – woman at 35 weeks pregnant told she needed a caesarean but demanded the baby be born naturally, even though risk to baby and mother as a result. This was because she didn’t believe in medical intervention in pregnancy. Hospital detained woman under s.2 Mental Health Act 1983, as her decision seemed so irrational it raised questions about her competency! Declaration was given that the caesarean was permissible, however, after the birth judicial review held that this was unlawful. Her depression was not a mental condition of the kind required by the Mental Health Act CONTRAST

2. Re MB (An Adult: Medical Treatment) (CA) – 40 weeks pregnant woman refused caesarian section because she had a phobia of needles so couldn’t consent to anaesthesia. Her life and that of her unborn child were therefore at risk. CA held that this woman’s view was so outrageous in defiance of logic that she was temporarily incompetent so that forcing the needle would have been acceptable

3. Coleman and Drake – where individual’s decision is utterly unreasonable the patient is declared incompetent – St George’s was an example of this

MAIN CASES

1. Re B

• Competent woman no longer wanted to be kept alive by means of artificial ventilation so wanted it to be withdrawn

• She got a declaration from the court that the hospital was acting unlawfully by refusing her

• A competent patient has the right to refuse treatment

2. Re C

• C had paranoid schizophrenia and was refusing an amputation which doctors considered was necessary to save his life

• Court sided with C, even though he had mental illness it didn’t mean he automatically lacked capacity

• Patients who can understand...