Advance Care Directives in practice

Mr A (“A”) was a patient admitted to the emergency department of a hospital, suffering from septic shock and respiratory failure. Although all appropriate treatment had been given to A, his condition deteriorated, he developed renal failure and was being kept alive by mechanical ventilation and kidney dialysis.

At this stage the hospital became aware that a year before his admission A, had a solicitor prepare an appointment of enduring guardianship directing his guardians to

“refuse consent for a TRANSFUSION of whole blood, red cells, white cells, platelets, or blood plasma to be given to me under any circumstances”

On a separate worksheet completed in his handwriting A indicated that he did not wish to have dialysis. A’s solicitor told the Court that when he prepared the document he explained the risks of refusing a blood transfusion to A but not the risk of refusing dialysis.

The hospital sought a Court declarations to the effect that the document was a valid “Advance Care Directive” and that it would be justified in complying with his wishes expressed in that directive. The Court considered that in making the decision to refuse dialysis A had legal capacity and it was clearly his own voluntary decision, therefore the hospital could not administer dialysis to A.

Mr A was unconscious and unable to give instructions as to his medical care therefore the hospital took steps to preserve his life whilst seeking the Court’s decision. The Court made orders recognising A’s right to refuse dialysis treatment as set out in the worksheet even though medical evidence suggested it would hasten A’s death.

If A had not completed the Advance Care Directive it would have been difficult for the hospital to follow A’s wishes. An Advance care directive is an important part of planning for your future and should be discussed with your loved ones at the time it is prepared.

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