Hi
Patient subject to detention under s2, appears to have a perfectly written, valid/applicable, signed, witnessed advance decision refusing ECT under all circumstances even if life is at risk whilst detained under the MHA. Patient currently lacks capacity.
RC still wants to override the AD and administer ECT under s62 to save life - can they or should we go to court to have it overridden even though there is no doubt regarding the validity?
If it’s to save life and RC states needed urgently for that then this completely overules any advance directive.
Ultimately MHA trumps it. And in fact if the RC were to not go down ECT route and patient died then RC would be the one on court and facing neglect charges.
To treat or not to treat?
https://emj.bmj.com/content/28/9/741
It does not automatically fall if there is a valid advance decision that it can be overridden. It’s a case by case basis.
The patient would be in their rights to challenge this , regardless of urgent treatment to save life and limb.
That’s why I would personally prefer court intervention over s62(a) - the advance decision is so articulate and very clear that they would not want ECT even if detained under the MHA and life was at risk - I have no doubt in my mind how distressing it would be for the patient - therefore we would expect a legal challenge.
Court intervention would provide assurance that the RC has justified the the need for ECT to be convincing and necessary including any potential faults, issues, limitations with the AD. How practical or useful would ECT be when say after two administrations the criteria under s62 is no longer justified, the course is incomplete and it cannot continue under s58A.
I’m also concerned the judge would not be happy with such an application because s62 (a) and (b) provides the authority to administer ECT even where there is an AD and there is no doubt about the validity of the AD either.
To a layman, like me, this is where it gets complicated, I have read and tried to understand the MHA, doesn’t 58A section 5c relate to this issue? Full disclosure, for me the right of a doctor to override the clear wishes of a person is difficult to come to terms with.
I think in order to effectively treat the patient one would need to understand how ECT would be incremental in saving the patient’s life?
S62 within the act allows overriding consent. But the key is not the application of the s62 to override - but whether or not the treatment required meets the necessary outcome?