Ethical Dilemma - 2
You are a District Nurse and have been attending a
man with severe Parkinson’s Disease. You visit
the patient as he seems to have deteriorated and now
cannot communicate verbally or write. The daughter
in law who has had to give up her job to care for your
patient says that he made an ADRT refusing “artificial
nutrition and hydration by any means including a feeding
tube in the future if his Parkinson’s Disease
is so severe he cannot swallow”.
You are presented with a form that states a valid and
applicable written ADRT for your patient. It has been
signed by the daughter in law and by a witness who
happens to be the patient’s 21 year old step
daughter. They claim the patient made the decision
a few weeks ago and got them to sign for him and in
his presence.
This ADRT has come as a surprise. ADRT was only a story
line on “Holby City Hospital” television
drama last night. What do you do? Do you challenge
the daughter in law of the authenticity of their claim?
Discussion
Before acting the professional must establish the facts
properly. The patient must be presumed to have capacity
and this must be maximised. Other forms of communication
could be used to confirm the decision including non
verbal signs, the use of assistive technology, involvement
of speech therapists. If the patient has now lost capacity the ADRT must
first of all be assessed for validity and applicability. If
the ADRT is valid the authenticity should only be challenged
if there is a justified reason for concern. Further
opinion from other people would be important including
social services especially if they are already involved. If
the authenticity of the ADRT is justifiably contested
a best interests / professional assessment by the senior
professional (in this case it could be the GP) should
be made. This might even involve the use of an Independent
Mental Capacity Advocate or other representative for
the patient. Any suggestion of abuse to this vulnerable
adult must be considered and acted upon based on local
policy |
