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alwaleed

Advance directive

5 posts in this topic

this is a probe in a PMP. a 27 year old lady took 100 paracetamols and refusing liver transplant. you found that she lacks capacity. but you found that she has an advance directive that under no circumstances should she be given an organ transplant. what would you do :-/

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As long as the paper work is clear and it was made when the patient had full capacity then you respect her decision

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i thought mental illness overrides any advance directive

In this case patient has taken overdose,we need to assess the intent of overdose,depressive symptoms,psychotic symptoms etc once we reach diagnosis then next is management.

As the patient lacks capacity ,for benefit of patient we need to treat her against her wishes.

The advance directive is not valid as mental illness overrides it.

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You would need to clarify when the advance directive was made and what was the particular reasoning behind it, could it be related to mental illness. If for example the directive was made because the lady had particular religious beliefs that prevented her from accepting a transplant to then provide her with one would land any doctor in more trouble than they could ever wish for. It would be wise to consult your defence union and discuss with family and surgical team before proceeding.

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As long as it was a proper advance statement made when she was of sound mind then it should stand. Ideally it would have been witnessed by a lawyer who had assessed she was competent to make such a decision. You would need to check with defence union and GMC for advice. Liaise with the medical team looking after her. Speak to rellies to explain situation.

If any doubt about validity of statement then could treat under common law, but dodgy legal ground.

There is also no mention of mental illness in this PMP per se. You should not assume that she lacks capacity because of a mental illness, it's more likely to be because of liver failure. On a technical note, in Scotland you can't lack capacity because of mental illness. What you have is SIDMA - significantly impaired decision making ability. Capacity only applies to physical illness. And yes I know that is silly and dualistic, but blame the Scottish Exec, not me!

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