Decision making for refusals of treatment—a framework to consider
Abstract
Challenges to practice are encountered on a daily basis by paramedics that often share many common recurring themes around consent or refusal to treatment. The benefits of training and open debate acknowledge the often complex decisions relating to consent and mental capacity and reduce opportunities for future legal challenge. How the law should be integrated into everyday decision making will be examined and a framework proposed to assist practice for defendable decision making. This article was inspired following joint training undertaken with paramedics and local critical incident managers from the police, which highlighted a need for a practical decision-making framework to be available for application during incidents and for use as an analytical tool to aid post-decision reflection and learning at debrief.
Police officers and paramedics often share constant challenges in real time situations relating to consent and capacity. Capacity is largely questioned only when a person refuses treatment which is believed to be required in their best interests. Typically this leads to police and ambulance staff questioning a person's capacity when they do not agree with the suggested care plan or treatment decision. If it is not felt suitable to make the decision by the attending staff, then ideally the person on scene will be able to call upon further assistance via telephone or radio, or by requesting the attendance of a more experienced colleague or one with a more senior position. However, mental capacity and assessment of capacity benefit from understanding of the guiding principles of the Mental Capacity Act 2005 (c.9) (MCA) and it is proposed that when they are applied, they make decision making more robust and confidence prevails.
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