The procedure for forming and recording an agreement on treatment withdrawal in the UK involves several steps to ensure informed consent and adherence to legal and ethical principles:
1. Initiation of Discussion:
- A healthcare professional, usually the doctor directly involved in the patient’s care, initiates the discussion about treatment withdrawal.
- This discussion should only occur when treatment is deemed no longer beneficial or when the burdens outweigh the potential benefits.
2. Assessing Capacity:
- The Mental Capacity Act (MCA) 2005 requires assessing the patient’s capacity to make decisions about their treatment. This involves determining if the patient understands the information presented, can retain it, weigh the pros and cons, and communicate their decision.
3. Information Sharing and Shared Decision Making:
- The healthcare professional must provide clear and comprehensive information about the patient’s condition, the proposed treatment withdrawal, and its potential consequences. This includes:
- The nature and severity of the illness.
- The expected benefits and risks of continuing treatment.
- Alternative treatment options (if any).
- The likely course of the illness if treatment is withdrawn.
- Palliative care options for comfort and pain management.
- Encourage open communication and answer any questions the patient or their family may have.
4. Considering Patient Wishes:
- If the patient is competent, their wishes regarding treatment must be respected, even if they choose to withdraw treatment.
- Explore past statements, advance directives (living wills), or healthcare proxy appointments to understand the patient’s preferences.
- If the patient lacks capacity, consider their likely wishes based on their values, beliefs, and previous discussions (if any).
5. Reaching Agreement:
- The goal is to reach a shared decision among the patient (if competent), their family (if involved), and the healthcare team. This decision should be based on the patient’s best interests, considering all relevant factors.
6. Recording the Agreement:
- Once an agreement is reached, it’s crucial to document it clearly and concisely in the patient’s medical records. This documentation should include:
- The date and time of the discussion.
- The healthcare professionals involved.
- The patient’s capacity assessment and their decision (if competent).
- Details of the agreed-upon treatment plan (withdrawal or continuation).
- Any specific wishes or preferences regarding care.
Additional Considerations:
- Second Opinion: In some situations, seeking a second opinion from another healthcare professional might be advisable, particularly in complex cases.
- Ethics Committee Involvement: If there are significant ethical concerns or disagreements, involving a hospital ethics committee might be necessary.
- Legal Consultation: In rare cases, legal consultation may be required to ensure all legal aspects are considered.