British Medical Association (BMA) Guidelines
The BMA has published a series of invaluable guidelines/proposals which address both the ethical and legal aspects of decision making in a number of situations which can arise in practice. Some guidelines have been developed as a collaborative exercise with other professional bodies such as the Royal College of Nursing. These guidelines, which are strongly recommended to readers of this text, are published in leaflet form and are available on application to the Publications Section of the BMA, BMA House, Tavistock Square, London WC1H 9JR. A summary of some of the key content areas incorporated in these guidelines which are relevant to be ethical and legal issues explored in this text is provided below. This summary does not cover the range of BMA guidelines available.
Collaborative Paper (BMA, RCN, Resuscitation Council).
This paper considers the background to 'do not resuscitate' (DNR) orders and situations when it appropriate to consider DNR decisions. The overall responsibility for such decisions is identified as lying with the medical consultant. This responsibility is discussed in relation to individuals involved in decision making and other wide- ranging factors which must be considered. These include express wishes of the patient; the family (addressing confidentiality); decision making involving the medical/nursing team. The contribution of factors such as the patient's medical condition, likelihood of success in CPR, and quality/duration of life are identified.
The responsibility for decision making is considered apropos, understanding of policies by staff, discussion of decisions with other health professionals and the crucial need to review decisions in the light of changes in the patient's condition. Recommendations are made concerning documentation of DNR decisions in medical and nursing records.
These proposals explore the issues and mechanisms for obtaining valid consent to treatment/diagnostic procedures, when patients are incapable of a full understanding by virtue of mental illness of handicap. A key proposal is that each health district establishes a committee (membership recommended) to provide a mechanism through which decision making in relation to valid consent can be obtained.
Levels of decision making are stratified at three levels, covering simple treatments/diagnostic procedures which involve minimal risk, to those which can result in serious risk to life. The role of the committee in delegating decisions (within defined limits) in certain situations is noted. The proposals also suggest that the Mental Health Act Commissioners could offer such a Committee guidance and support in fulfilling its function and also act in a supervisory capacity.