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Without trying to list my proofs - which are rather lengthy, and somewhat 'nebulous' - I consider that this decision is part of a recent trend: judges are now placing more stress on 'what the patient, even if not mentally capable, wishes to happen' compared to 'what looks like the best clinical decision'.
From what I read in the media, the judge was strongly influenced by both the patient's determination to resist the amputation, and the patient's previous experience of life, which was apparently difficult (extracted from the online report I read, reference 1):
'"(The pensioner) has had a hard life. Through no fault of his own, he has suffered in his mental health for half a century ... He has no next of kin. No-one has ever visited him in hospital and no-one ever will. Yet he is a proud man who sees no reasons to prefer the views of others to his own," said Mr Justice Jackson.
"I am quite sure that it would not be in (his) best interests to take away his little remaining independence and dignity in order to replace it with a future for which he understandably has no appetite and which could only be achieved after a traumatic and uncertain struggle that he and no-one else would have to endure."'
Judges are slowly making it clearer, what section 4 of the Mental Capacity Act, means. And about time, too.
As a doctor working in Amputee Rehabilitation, I was surprised by the stated expectation that following an amputation ‘the patient would never return to live in independent accommodation’.
The extent of this patient’s disability, and care needs, secondary to his mental health problems may have been preventing him from living independently, but providing he received good care in the rehabilitation phase, a below knee amputation should not.
After allowing six weeks for wound healing (during which domiciliary care would be needed in some form), we review a patient in an MDT outpatient setting for assessment. In an uncomplicated case, casting for prosthesis can start at that appointment. Once this limb is made, a typical diabetic patient in our service would learn to walk within three or four weeks. Many, if not most, return home to live in independent accommodation.
Competing interests:
No competing interests
20 October 2015
Jane Sarah Anketell
ST3 Rehabilitation Medicine
Regional Disablement Unit, Musgrave Park Hospital, Belfast
This decision is part of a trend toward looking at decisions more from the perspective of the patient
Without trying to list my proofs - which are rather lengthy, and somewhat 'nebulous' - I consider that this decision is part of a recent trend: judges are now placing more stress on 'what the patient, even if not mentally capable, wishes to happen' compared to 'what looks like the best clinical decision'.
From what I read in the media, the judge was strongly influenced by both the patient's determination to resist the amputation, and the patient's previous experience of life, which was apparently difficult (extracted from the online report I read, reference 1):
'"(The pensioner) has had a hard life. Through no fault of his own, he has suffered in his mental health for half a century ... He has no next of kin. No-one has ever visited him in hospital and no-one ever will. Yet he is a proud man who sees no reasons to prefer the views of others to his own," said Mr Justice Jackson.
"I am quite sure that it would not be in (his) best interests to take away his little remaining independence and dignity in order to replace it with a future for which he understandably has no appetite and which could only be achieved after a traumatic and uncertain struggle that he and no-one else would have to endure."'
Judges are slowly making it clearer, what section 4 of the Mental Capacity Act, means. And about time, too.
Ref 1:
http://www.expressandstar.com/news/uk-news/2015/09/29/mentally-ill-pensi...
Competing interests: No competing interests