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By Baroness Greengross - 16th January 2012
Baroness Greengross calls on the government to codify how Advance Decisions regarding medical treatment preferences are dealt with.
Today in a Lords Parliamentary Question I will be asking HMG 'what measures are in place to inform people of the steps they need to take to ensure their wishes regarding medical treatment at the end of life are respected if they lose capacity'.
It is well established that if they are concerned about having a lack of capacity in the future, competent adults can make a statement explaining medical treatments they would not want at that future time. The statement, verbal or written, is called an 'advance decision to refuse treatment', which is legally binding. They have a right to refuse treatment and to expect that their medical treatment preferences should be respected as far as possible. An Advance Decision only applies where a person wants to refuse medical treatments, and cannot be used to ask for specific medical treatment, or anything that is against the law.
The point of my question is to elicit confirmation from the minister as to what systems the NHS uses, both to record the existence of Advance Decisions (and any other documents recording patients' medical treatment preferences), and to ensure that these are accessible to, and therefore can be respected by, doctors? If he is unable to give that confirmation of both, then I will be seeking assurances that he will put in place measures to ensure that those decisions are recorded and respected.
Further, I will also be seeking confirmation from the minister as to what evidence the Department of Health has on the degree of adherence to patients' end-of-life medical preferences, where they have clearly made an Advance Decision in this regard, i.e. how are a patient's wishes made known, recorded, complied with and audited? How is the whole process monitored and what follow-up and remedial action is taken if the patient's Advance Decision is not complied with – even for a good reason like changed circumstances?
My purpose here is to codify how Advance Decisions regarding treatment preferences are dealt with, and to strengthen the position of clinical staff when difficult choices have to be made, often under pressing circumstances and late at night – for example, with a mental health condition. It cannot be left to individual whim, or institutional chance, that Advance Decisions, having been carefully thought through, are not communicated, ignored or not complied with for no good reason.
Baroness Greengross of Notting Hill in the Royal Borough of Kensington and Chelsea was raised to the peerage in 2000.
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