Critical evaluation of advance statements from patients lacking mental capacity

Advance refusals of medical treatment present complex dilemmas with ethical, moral and legal facets. A competent patient may refuse any treatment, even where the decision may lead to an untimely death. The same holds true with respect to an incompetent patient with an advance directive made when that patient was competent and there is no reason to believe that the patient has changed his or her mind.Advance statements arise from respect of patient autonomy and the introduction of The Mental Capacity Act 2005, which aims to provide consistently better protection and greater empowerment for vulnerable people and their autonomous rights.This article outlines how the patient's right to choose in advance how they are to be treated if not competent to make his own treatment decisions is a positive development in the law. However, it may be of limited effect, as the majority of people will probably never make an advance statement. As a result, we should educate both patients and doctors about their rights in relation to medical decision-making, particularly as our increasing ability to prolong life makes decisions to terminate life-sustaining treatment more common. In order to respect patient autonomy, avoid harm to patients and reduce the risk to paramedics of civil or criminal liability, paramedics need to determine the legal validity of advance directives before making their treatment decision. In cases of uncertainty treatment decisions should be made in the patient's best interests while legal advice is sought as to the validity of the directive.

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