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The Student Clinical Ethics Committee considered the case of an elderly woman who remained in hospital for 2 months after treatment, despite being considered medically fit for discharge, causing her great distress. The committee considered the justifications for keeping the patient on the ward in order to determine whether she was fit to be discharged to her home. The case study summarises the reflections of the committee and focuses on the capacity of the patient to make the decision to go home, the potential risks and consequences of discharging her, the concerns of the health care teams and their responsibility to make a decision. [ABSTRACT FROM AUTHOR]

This article examines how the wishes, feelings, values and beliefs of adults lacking capacity can be evaluated and the extent to which they are given effect in best interests decision-making. One way of fulfilling the clinician’s legal responsibilities to take a patient’s preferences into account is to explicitly link these to the notion of narrative. Narratives provide a compelling grounding and give weight to views and values that may have been informally and consistently expressed in the past. An evaluation of recent case law suggests that the trajectory of a person’s life, their character and personality, and the perspectives of those with whom the patient has valued relationships are given increasing judicial recognition. Attending to the narrative of the patient could lead to a more sophisticated judgement of best interests than an objective ‘balance sheet’ approach would allow and enable greater alignment with the UN Convention on the Rights of Persons with Disabilities. [ABSTRACT FROM PUBLISHER]

The Mental Capacity Act 2005 introduced a statutory framework for advance decisions, thus promoting autonomous healthcare decision making in advance of loss of capacity. In order to be valid and applicable, and so binding on healthcare professionals, advance decisions refusing treatment ( ADRT) must specify treatments to be refused and the circumstances of refusal. Recent case-law indicates that a high level of specificity is required for advance refusals of life-sustaining treatment and, in contrast to a presumption of capacity for contemporaneous decisions, in some circumstances capacity must be demonstrated at the time of making the advance decision. In comparison with the 'stringent' requirements for ADRT, the more generic Advance Care Planning ( ACP) is gaining more prominence in end of life decision making. The paper explores recent case-law and its impact on the effectiveness of ADRT in practice and compares with ACP. [ABSTRACT FROM AUTHOR]

This article considers the provisions of the Mental Capacity Act 2005 in respect of advance decisions. It considers the new statutory regulation of advance directives (termed 'advance decisions' in the Act) and the formalities necessary to effect an advance decision purporting to refuse life-sustaining treatment. The validity and applicability of advance decisions is discussed with analogy to case law and the clinician's reasonable belief in following an advance decision is considered. The article assesses the new personal welfare Lasting Powers of Attorney, the situation where an attorney purports to refuse life-sustaining treatment on behalf of the donor, and the contrast between best interests and substituted judgment. [ABSTRACT FROM AUTHOR]

This article examines the standard of disclosure, set by law, of risks of treatment and alternative procedures that should normally be disclosed to patients. Therapeutic privilege has been recognized by the courts as an exception to this standard of disclosure. It provides a justification for withholding such information from competent patients in the interests of patient welfare. The article explores whether this justification is either legally or ethically defensible. In assessing patient welfare, the health care professional is required to consider the patient's overall best interests – but this is not limited to an assessment of medical best interests. It is contended that the health care professional is neither qualified nor justified in making such a judgement, as the law recognizes that a competent adult patient determines her own best interests. This is not possible without sufficient information of risks to inform the decision. [ABSTRACT FROM AUTHOR]

Provides information on several medical techniques and equipment in patient care. Technique in cleaning oral endotracheal tube; Health teachings for diabetics; Cleaning of wounds.

Objective: To investigate the provision of care for pediatric and adolescent patients by gynecologic oncologists.Methods: The present prospective cross-sectional study enrolled attending physicians and fellows specializing in gynecologic oncology from the USA during December 2012 and January 2013. A 33-question survey collecting demographic data and details of participant opinions on existing practices was distributed to potential respondents. Survey responses were aggregated and descriptive analyses were performed.Results: The survey was distributed to 1252 physicians and 178 (14.2%) surveys were returned; 105 (59.0%) participants thought that the care of patients aged younger than 21 years should be included in their practice. Only 7 (3.9%) participants had received formal training in caring for pediatric patients and young adults; however, 85 (47.8%) felt this should be incorporated into formal fellowship training. Multidisciplinary teams were reported to be the best method for caring pediatric patients by 160 (88.9%) participants but only 42 (23.6%) participants reported that multidisciplinary teams were involved in pediatric gynecologic oncology care at their institutions.Conclusion: Gynecologic oncologists wanted to be involved in pediatric care and open dialogue between specialists could help in the provision of optimal, longitudinal care to these patients. Furthermore, the incorporation of formal pediatric patient-focused training into gynecologic oncology fellowship programs should be considered. [ABSTRACT FROM AUTHOR]