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Ethical quesion involving refusal to eat and drink

With my Imperial interview coming up soon, I've been revising patient consent (my BMAT essay topic). I was wondering, if a patient refuses food or water, what should a doctor do? Should they stand back and let the patient die. If not, how would you go about feeding the patient? Would you have to sedate them? Your thoughts please.

Reply 1

Madprof

12

Hmm, interesting issue. What would you do?

I'm fairly sure there is standard practice in this case ... something to do with not allowing the patient to effectively commit suicide and this overiding their right to refuse treatment? Spect it's googleable.

Reply 2

north bank gooner

OP

At my UCL interview I was asked about this and I said feed the intravenously. I was then asked what if they resisted, and I said anaesthatise them. The interviewers just had blank looks on their faces so I didn't know whether this was the "right" or "wrong" answer. I know that it is important to express you own opinion, but I'm sure there are some situations in which there is a "correct" answer.

Reply 3

Philosoraptor

18

Um, a good thing to check your answer would be the question, Did you get a place?

Reply 4

Johnny C.

9

arsenalrulz

At my UCL interview I was asked about this and I said feed the intravenously. I was then asked what if they resisted, and I said anaesthatise them. The interviewers just had blank looks on their faces so I didn't know whether this was the "right" or "wrong" answer. I know that it is important to express you own opinion, but I'm sure there are some situations in which there is a "correct" answer.

Jeez, anaesthatise them!!!! :eek:

you realise that's assault if you don't have their consent and so is inserting an IV drip and so is stuffing food and water down someone's mouth.

If a patient refuses treatment or refuses to eat, you can't do anything for them even if it means they will die. The only exception to this is if the patient is sectioned under the mental health act, where doctors can then act in the best interest of the patient.

Reply 5

Renal

17

Jesus wept!

Reply 6

north bank gooner

OP

Johnny C.

Jeez, anaesthatise them!!!! :eek:

you realise that's assault if you don't have their consent and so is inserting an IV drip and so is stuffing food and water down someone's mouth.

So THAT'S why I got rejected lol

Reply 7

Revenged

15

There is no such thing as a right or wrong answer in ethics...

If you ever get asked a question just give both sides of the argument and you'll be fine...

If you only give one side of an argument you are always going to be asked "well what if..." and you may be trapped...

Reply 8

username43584

8

I suppose you could mention the Hippocratic Oath and say that it's your responsibility to do the best for the patient, even if it is against their wishes. I know some hunger strikers are force-feed intravenously - even though they're usually criminals, they still have the same rights as everyone else so presumably it follows on that one could override the consent of the average person in their best interests.

I was asked about something similar in my Oxford interview - what would you do if a Jehovah's witness was bleeding to death in front of you? (the significance of which was completely lost on me - the interviewer assumed that I knew Jehovah's witnesses wouldn't accept blood transfusions simply because I'm Irish :s-smilie:

) I can't remember how I answered. I just usually go where the spirit takes me on the day.

Reply 9

north bank gooner

OP

I heard somewhere that the Hippocratic Oath is not undertaken in the UK, though Im not sure if it was a reliable source

Reply 10

Fluffy

15

arsenalrulz

With my Imperial interview coming up soon, I've been revising patient consent (my BMAT essay topic). I was wondering, if a patient refuses food or water, what should a doctor do? Should they stand back and let the patient die. If not, how would you go about feeding the patient? Would you have to sedate them? Your thoughts please.

If the patient is of sound mind, there is nothing you can realistically do - to feed them is ABH/GBH. If the patient is not of sound mind, you can get a court order to feed them.

A tricky issue comes when you have two consultants involved, one thinks patient is compus mentus, the other does not...

Reply 11

username43584

8

I was always under the impression it was (I may even have mentioned it in interview) but even if it isnt formally undertaken, it's definitely something that an awful lot of doctors are going to be aware of. It's a real principle of the doctor-patient relationship.

Reply 12

Fluffy

15

arsenalrulz

I heard somewhere that the Hippocratic Oath is not undertaken in the UK, though Im not sure if it was a reliable source

See duties of a doctor - taken from the Hippocratic Oath. Also see the modern hippocratic oath, cited at graduation...

Reply 13

Johnny C.

9

I've heard that on occasion there are "right" answers to ethical questions, although the interviewers still want to hear both sides of the argument...

Basically if something is currently illegal, the interviewers don't want to hear you say that is what you would do.. So in the force-feeding question, the "right" answer is that you wouldn't force-feed the patient but you would try to convince the patient to change their mind.

Interestingly, I've heard that on euthanasia questions, they don't like to hear applicants arguing in favour of euthanasia even it it was hypothetically legal. The chief concern of a doctor being to preserve life and all that jazz...

Reply 14

Renal

17

I think the key message is to never come down on one side of the fence unless the answer is blindingly obvious. Argue around it and discuss with the panel.

However, in a similar vein, what would you do with a muslim patient who refuses to eat or drink (or take meds) during ramadan?

Reply 15

Philosoraptor

18

Probably wait till dusk, that's fair enough I think

Reply 16

Johnny C.

9

Renal

I think the key message is to never come down on one side of the fence unless the answer is blindingly obvious. Argue around it and discuss with the panel.

However, in a similar vein, what would you do with a muslim patient who refuses to eat or drink (or take meds) during ramadan?

Err, remind them that their religion doesn't require them to fast during Ramadan if they are ill :smile:

Reply 17

Philosoraptor

18

or that

Reply 18

Renal

17

Johnny C.

Err, remind them that their religion doesn't require them to fast during Ramadan if they are ill :smile:

Err, not only do most of them not believe that, they certainly won't believe that when I tell them.

Reply 19

Johnny C.

9

I think most muslims do believe it, in fact I'm certain the Qur'an specifically says those in ill-health should not fast.

Check this link:
http://en.wikipedia.org/wiki/Sawm

Wikipedia knows all :smile:

Ethical quesion involving refusal to eat and drink

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