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Editor--the evidence of Ms B leaves little doubt that she makes a
competent decision to refuse life-saving treatment(1).
During the hearing Mr Francis wondered whether Ms B’s anger about the way
she has been treated affects her capacity. I would think it is sad enough
that the patient is angry about the fact that her wishes are not
respected. To suggest that her feelings affect her capacity seems to make
the whole situation worse.
However I am surprised about the way Dame Butler-Sloss rejects the
argument that the doctors were concerned to establish Ms B’s competence.
She seems almost to equate concerns with paternalism. It is her who states
in an important judgement about establishing a patient’s competence: “the
graver the consequences of the decision, the commensurately greater the
level of competence is required to take the decision”(2).
The decision to refuse treatment with the immediate consequence of death
is certainly the gravest decision a person is able to make. It is
understandable that doctors are worried about the competence of patients
in these situations. Of course once competence has been established,
health care professionals as any other member of the society must respect
the wish of a patient. In the case of Ms B one might suspect that the
hospital held up the decision to comply with her wishes although it was
evident that the patient was able to make such a decision. Such behaviour
is certainly unacceptable and very paternalistic.
In the real world we all have to negotiate to get what we are
entitled to and to find out about the limits of our rights and interests.
The case of Ms B is a good example that some doctors still need to learn
about the limits of their power and respect a patient’s wishes even if
they find it hard to do so and disagree with the decision. However the
case illustrates also that it takes time to establish the true wishes of a
patient in these situations. Sometimes it might be difficult to draw the
line between understandable worries and disrespecting a competent
patient’s wish. Doctors and patients should be given enough time to find
the right decision in situations where the consequences are as grave as in
the situation of Ms B.
1. Dyer C. Woman makes legal history in right to die case. BMJ 2002;
324: 629
2. Re MB (an adult: medical treatment (1997) 38 BMLR 175 (CA) per Dame
Butler-Sloss
Competing interests:
No competing interests
19 March 2002
Jan Schildmann
Postgraduate student
Centre od Medical Law and Ethics, King's College London, Strand WC2R 2LS
Ms B: understandable concerns vs. paternalism
Editor--the evidence of Ms B leaves little doubt that she makes a
competent decision to refuse life-saving treatment(1).
During the hearing Mr Francis wondered whether Ms B’s anger about the way
she has been treated affects her capacity. I would think it is sad enough
that the patient is angry about the fact that her wishes are not
respected. To suggest that her feelings affect her capacity seems to make
the whole situation worse.
However I am surprised about the way Dame Butler-Sloss rejects the
argument that the doctors were concerned to establish Ms B’s competence.
She seems almost to equate concerns with paternalism. It is her who states
in an important judgement about establishing a patient’s competence: “the
graver the consequences of the decision, the commensurately greater the
level of competence is required to take the decision”(2).
The decision to refuse treatment with the immediate consequence of death
is certainly the gravest decision a person is able to make. It is
understandable that doctors are worried about the competence of patients
in these situations. Of course once competence has been established,
health care professionals as any other member of the society must respect
the wish of a patient. In the case of Ms B one might suspect that the
hospital held up the decision to comply with her wishes although it was
evident that the patient was able to make such a decision. Such behaviour
is certainly unacceptable and very paternalistic.
In the real world we all have to negotiate to get what we are
entitled to and to find out about the limits of our rights and interests.
The case of Ms B is a good example that some doctors still need to learn
about the limits of their power and respect a patient’s wishes even if
they find it hard to do so and disagree with the decision. However the
case illustrates also that it takes time to establish the true wishes of a
patient in these situations. Sometimes it might be difficult to draw the
line between understandable worries and disrespecting a competent
patient’s wish. Doctors and patients should be given enough time to find
the right decision in situations where the consequences are as grave as in
the situation of Ms B.
1. Dyer C. Woman makes legal history in right to die case. BMJ 2002;
324: 629
2. Re MB (an adult: medical treatment (1997) 38 BMLR 175 (CA) per Dame
Butler-Sloss
Competing interests: No competing interests