Advanced Care Planning Flashcards
What is Power of Attorney?
This is a legal document drawn up by a competent adult that nominates another person to make decisions on their behalf. This can be related to financial and property, or health and welfare. It can only be used when that adult has lost capacity.
What is an advance directive?
An advance directive is a medical decision made by a patient with capacity, regarding their future wishes for treatment. It only comes into force if a patient subsequently lacks capacity.
What are the 5 key principles underpinning the MCA?
Capacity is assumed; it needs to be proven otherwise
Enabling people to make their own decisions
Unwise decisions
Best interests
Less restrictive option
What criteria must be fulfilled in order for an Advanced Decision to be legally binding?
It must be valid (this means it must have been made at a time when the individual had capacity to make that decision).
It must be applicable (this means the wording must be specific to the medical circumstances, and not vague or unclear).
It must have been made when the individual was over 18, and fully informed about their decision.
It must not have been made under the influence or duress of other people
It must be written down, be signed and witnessed (if it concerns a refusal of life-saving treatment)
What is an Advanced Decision and what does it include and not include?
An Advanced Decision, short for Advanced Decision to Refuse Treatment, is a legally binding document. Its purpose is to ensure that an individual can refuse a specific treatment(s) that they do not want to have in the future.
Treatments that can be refused include life-sustaining treatments.
It cannot refuse basic care (such as washing), food or drink by mouth, measures designed purely for comfort (e.g. painkillers), or treatment for a mental health condition if the individual is sectioned under the Mental Health Act.
It can also not demand specific treatment or something that is illegal (e.g. assisted dying).
What is an Advanced Statement and what are the legal implications of it?
An Advance Statement is sometimes called a “Statement of Wishes and Care Preferences”. It allows an individual to make general statements about their wishes, beliefs, feelings and values and how these influence their preferences for their future care and treatment.
An Advance Statement is not by itself legally binding, but legally must be taken into consideration when making a “best interests” decision on someone’s behalf under the Mental Capacity Act (MCA), 2005. This is because one of the criteria of the MCA is that a patient’s “wishes, feelings, beliefs and values” must be taken into consideration; an Advanced Statement provides evidence of this.
What might be included in an Advanced Statement (statement of wishes and care preferences)?
Information that can be included in an Advanced Statement can be anything that is important to the individual. This might include:
Religious or spiritual views, and those that might relate to care
Food preferences
Information about your daily routine Where you would like to be cared for (in hospital, at home, in a care home etc.)
Any people who you would like to be consulted when best interests decisions are being made on your behalf (however this does not give the same legal power as creating a Lasting Power of Attorney)
What is the doctrine of the double effect?
What might be considered ‘End of Life’?
End of life or the dying phase can be recognised when people are reaching
the following stages in their disease trajectory:
o Bed bound.
o Semi comatose.
o Only able to take sips of fluid.
o Unable to take medicine orally
What symptoms might people face at the end of life phase?
o Pain
o Nausea and Vomiting
o Dyspnoea
o Agitation
o Confusion
o Constipation
o Anorexia
o Terminal Secretions
How should death certification state cause of death?
o 1a – Cause of death
o 1b – Condition leading to cause of death
o 1c – Additional condition leading to 1b
o 2 – Any contributing factors or conditions
When should death be reported to a coroner?
A death should be reported to the coroner when a doctor knows or has
reasonable cause to suspect that the death:
o occurred as a result of poisoning, the use of a controlled drug,
medicinal product, or toxic chemical;
o occurred as a result of trauma, violence or physical injury, whether
inflicted intentionally or otherwise;
o is related to any treatment or procedure of a medical or similar nature;
o occurred as a result of self-harm, (including a failure by the deceased
person to preserve their own life) whether intentional or otherwise;
o occurred as a result of an injury or disease received during, or
attributable to, the course of the person’s work;
o occurred as a result of a notifiable accident, poisoning, or disease;
o occurred as a result of neglect or failure of care by another person;
o Was otherwise unnatural
The coroner should also be informed where:
o The death occurred in custody or otherwise in state detention – of whatever cause. This includes Deprivation of Liberty Safeguarding
authorisations (DoLS).
o No attending practitioner attended the deceased at any time in the 14 days prior to death or no attending practitioner is available within a
reasonable period to prepare an MCCD;
o The identity of the deceased is unknown.
What is the role of the coroner?
The coroners role is determine who died, where they died and how they died.
They do not comment on care but do have powers to insisit on further local
investigation.
How should N&V be managed when is a result of reduce gastric motility?
Pro-kinetic agents are useful in these scenarios as the nausea and vomiting is usually resulting from gastric dysmotility and stasis
According to NICE CKS and BMJ best practice, first-line medications include metoclopramide and domperidone
However, NICE CKS indicate that metoclopramide should not be used when pro-kinesis may negatively affect the gastrointestinal tract, particularly in complete bowel obstruction, gastrointestinal perforation, or immediately following gastric surgery
How should N&V be managed when is a result of chemically mediated aetiology?
If possible, the chemical disturbance should be corrected first
In the context of other chemically mediated syndromes, for example due to opioid medications, there are a number of suggested medications
Key treatment options include ondansetron, haloperidol and levomepromazine
