Advance directives, best interests and clinical judgement: shifting sands at the end of life.

Full Abstract

End-of-life issues for clinical practice present complex ethical, moral and legal dilemmas that have been heightened by advances in medical technology enabling a dying patient to be kept alive for longer than ever before. Respect for patient autonomy and dignity are fundamental ethical components that engage in end-of-life decision-making. A mentally competent individual has the absolute right to refuse medical treatment for any reason and a valid advance directive for the refusal of treatment is binding in the event that the person loses capacity. In the incompetent patient, the withdrawal of life-sustaining treatment is based on the 'best interests' test, developed on a model that takes into account the welfare considerations of the person concerned. It is questioned whether the test should be more subjectively based, and accord greater weight to the wishes that might have been in the mind of the incompetent person approaching the end of life. The Mental Capacity Act 2005 (expected to come into force in 2007) provides a statutory framework for the law relating to advance directives, capacity and best interests. This paper examines contemporary issues surrounding end-of-life decision-making against the backdrop of the existing and proposed legal framework.

Learn Faster Today Improve your study skills

Author information

Author/s: Samanta, Ash (A); Samanta, Jo (J);

Affiliation: University Hospitals of Leicester NHS Trust. ash.samanta(-atsign-)uhl-tr.nhs.uk

Journal and publication information

Publication Type: Journal Article; Review

Journal: Clinical medicine (London, England) (Clin Med), published in England. (Language: eng)

Reference: -2006 May-Jun; vol 6 (issue 3) : pp 274-8

Dates: Created 2006/07/07; Completed 2007/01/12;

PMID: 16826861, status: MEDLINE (last retrieval date: 12/26/2008)

Sourced from the National Library of Medicine. Abstract text and other information may be subject to copyright.

Comments and Corrections

CommentIn: Clin Med. 2006 May-Jun;6(3):231-3. (PMID: 16826850)

External Links for this article (including full text providers, if available):

Click Electronic Full-text Provider Links to see options for finding the electronic full text links to this article. Note there may be a subscription or fee required for access to the full text. See our FAQ for information on finding FREE full text articles.

This article may also be located in paper journal collections available in many libraries. Use the Journal and Publication Information above to find the full article.

MeSH headings (categories)

This article was linked to the MESH Headings shown below.

Humans
Informed Consent - legislation & jurisprudence
Life Support Systems
Living Wills
Mental Competency - legislation & jurisprudence
Patient Rights - legislation & jurisprudence
Philosophy, Medical
Terminally Ill

These are the highest related articles currently in the database:

Advance healthcare directives. 29 Apr 2006
Telecare: perspectives on the changing role of patients and citizens. 30 Dec 2004
Palestinians: the crisis in medical care. 13 Mar 2007
Death by the numbers. 26 Jun 2007
Better value healthcare--the 21st century agenda. 30 Dec 2006
Ethical challenges of telemedicine and telehealth. 30 Dec 2007
Outcomes research: priorities for an evolving field. 30 Mar 2004
China's evolving health care market: how doctors feel and what they think. 30 Aug 2004
New models of care in family medicine. 30 Oct 2004
Labor markets and employment insecurity: impacts of globalization on service and healthcare-sector workforces. 29 Sep 2004

See 100+ related articles.