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Centre for Policy on Ageing | |
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Geriatricians' views of advance decisions and their use in clinical care in England
— qualitative study | | Author(s) | Catherine Jane Bond, Karen Lowton |
| Journal title | Age and Ageing, vol 40, no 4, July 2011 |
| Pages | pp 450-456 |
| Source | http://ageing.oxfordjournals.org/ http://www.bgs.org.uk/ |
| Keywords | Medical care ; Terminal care ; Advance directives ; Geriatricians ; Attitude. |
| Annotation | An anticipatory decision document records a person's wishes regarding medical treatment at a time when they have capacity to make choices, to be enacted when that capacity is lost. In England and Wales an advance decision to refuse treatment (ADRT), a legally binding document, is currently rarely used. A disparity is suggested to exist between physicians' support for anticipatory decisions in principle and their lack of impact on decision-making in practice. The aim of the present study was to elicit geriatricians' views on advance decisions and their use in decision-making in England. Study findings showed that geriatricians held positive views on anticipatory decisions in principle. In practice, they reported being highly likely to follow a decision which was in line with their clinical view. They would also favour an ADRT which was prescriptive in terms of the situation and treatment to which it applied. However, geriatricians expressed concerns in relation to patient understanding of the role and limits of these documents. Participants expressed discomfort in following an ADRT which, in their professional opinion, did not represent the patient's best interests, despite it being a legally binding document. A conflict between doctors' beneficence and patients' autonomy was apparent, with geriatricians differing in their views on how ADRTs should fit into medical decision-making, and particularly how far anticipatory decisions can represent ongoing patient autonomy. Despite its status in law, an ADRT which conflicts with a geriatrician's clinical opinion may not be implemented, resulting in a breach of the Mental Capacity Act. (JL). |
| Accession Number | CPA-110922004 A |
| Classmark | LK: LV: CXB: QT4: DP |
Data © Centre for Policy on Ageing |
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| ...from the Ageinfo database published by Centre for Policy on Ageing. |
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