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Medical ethics and recent news and breakthroughs (medicine applicants)

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Reply 180

nexttime

Original post by JMJ_1996

You cannot hold a child down a force them to have something they don't want to have, that would be hugely unethical

Are you kidding me? That happens literally all the time! Have you met any 3 year olds recently? :tongue:

If you mean a child with capacity, then that also happens, especially in the context of mental health.

It used to be the case that a child could not refuse treatment, but reading around it seems recent case law has back tracked on that a little bit. The medical defence lawyers now recommend seeking legal advice on a competent child refusing treatment.

If its an emergency and the treatment is needed to keep them alive before courts can be involved, you very definitely can force them to have treatment no matter how competent they may be.

Reply 181

Revenged

An NHS Foundation Trust Hospital v P [2014] EWHC 1650 (Fam)

Application for, inter alia, a declaration that it was lawful for medical practitioners entrusted with a 17 year old patient's care to treat her for an overdose notwithstanding that she refused treatment. Application granted.
P is a 17 year old with a history of self-harming who took an overdose of Paracetemol. She refused to consent to treatment when admitted to hospital. The consultant psychiatrist at the hospital gave the opinion that although P suffered from a personality disorder, it was his view that she had capacity to make decisions about her medical care.

Paracetemol overdoses need treatment within 8 hours to avoid liver failure and death. The hospital Trust thus made an urgent out-of-hours application for a declaration that it was lawful for the medical practitioners entrusted with P's care to treat her for the overdose notwithstanding that she refused treatment. They also sought an order that any steps that might amount to a deprivation of liberty were also lawful – in the event that they found it necessary to restrain or sedate P in order to treat her.

In making the orders, the Judge considered Re W (a minor) (medical treatment: court jurisdiction) [1993] and Re P (Medical Treatment: Best Interests) [2004], to support the premise that where a child under 18 (although Gillick competent) refuses treatment, the court may exercise its inherent jurisdiction and override the child's wishes if it is in her best interests and consent to her treatment.

Link:
http://www.familylawweek.co.uk/site.aspx?i=ed129874

Children without capacity you must get the permission of the parents first. In children without capacity it is the parents of children is that the parents have the power, not the doctors. You must remember this. It is very common to take simple investigations like bloods and cannula for patients who lack capacity (dementia patients) but in children you need the consent of the parents before doing so. If the parent did not allow me to take a blood test on the their child then I would not do it. I will explore it and try and convince them why it is needed. If they cannot be convinced then what can you do? You are not going to force a child down with a mother that is screaming at you not do. Firstly they have the legal right, second you would in a lot of trouble, thirdly under the law you could have trouble with the GMC / battery.

The power is with the parents. In real life in someone with capacity, especially in a child, try everything you possibly can to get the family or patient to agree. Restraint or force only in absolute emergencies. You have to be able to justify it afterwards and you may not be acting lawfully. Parents have the legal right to make unwise decisions for their children and they can do so. The art is convincing them to do the right thing for their child but if they want to pick unwise decisions they can, unless it is real emergency or life threatening then you need to respect their rights.

Reply 182

Revenged

Original post by JMJ_1996

I haven't checked but many doctors I have spoken to seem to agree with me. I don't think the book is gospel and maybe their are different situations. You cannot hold a child down a force them to have something they don't want to have, that would be hugely unethical

Forcing children to have blood tests, operations, etc. is normal practice when young. They do not have the capacity so you can do and in young children vertually all tests are done with many tears and tantrums. The important part is that you will need parental permission. a parent who refuses a test on a child is very powerful. In this case you cannot do the test, restraint or not.

(edited 9 years ago)

Reply 183

username1694751

Original post by Revenged

So a competent child can't refuse something in England / Wales? aha - I want to clear this up!!

Reply 184

Revenged

Original post by Blue4Life

So a competent child can't refuse something in England / Wales? aha - I want to clear this up!!

They can refuse but they do not have legal right to refuse. This is why you have to go to their parents for consent when they refuse.

Reply 185

Revenged

The exceptions to this would be forcing a feeding tube on an anorexic child against their will (can be done under the mental health act for treatment for their mental health condition) or if they refuse to give permission to you to contact their parents. For example, if a 16 year old came to the GP and refused to go for a test then whatever I thought I would leave it. I certainly would not then phone the mother or father up, as it is breach of confidentiality. So yes, always exceptions. Try to find real life solutions !

Reply 186

Etomidate

Original post by Blue4Life

So a competent child can't refuse something in England / Wales? aha - I want to clear this up!!

Not in England (dunno bout Wales). But there is an interesting difference between capacity to consent and capacity to refuse.

Reply 187

username1694751

Original post by Etomidate

Not in England (dunno bout Wales). But there is an interesting difference between capacity to consent and capacity to refuse.

Right - thought so :smile:

Reply 188

Revenged

i misunderstood the thread. if you are all wanting advice for interview then please dont try to learn this stuff.

if you are asked something like :

"mr x is 16 and is refusing life saving treatment, his family does not consent either. you are the doctor, should you operate"

never ever commit to an answer right at the start. think always - vague politicians answer with the positive and negatives of both. if you must come up with an answer it needs to be at the end after great spiel and analysis of both options. this is what they will be looking for. HTH

(edited 9 years ago)

Reply 189

Elatadi

Hey guys!

There's a very interesting online course (MOOC) on bioethics dealing with some crucial questions at edX.org. It's already archieved but you can still view all the courseware. I have started it only today, so I can't judge the whole course, but as far as I've seen it's very interesting and helpful!

Here's the link: https://www.edx.org/course/introduction-bioethics-georgetownx-phlx101-02x

Reply 190

Lularose83

Btw I recommend this book called 'law and medical ethics'... it's really chunky and maybe goes into too much detail but outlines major bioethical issues such as xenotransplantation, consent, genetic testing, abortion, stem cells, mental health, autonomy!