Advance healthcare directive for healthcare professionals and Designated Healthcare Professionals
Life-sustaining treatment in an advance healthcare directive
Amy suffered severe brain damage as a result of a head injury and, despite all rehabilitative efforts, was left lacking decision-making capacity and had difficulty swallowing. She had previously made an advance healthcare directive stating that she would not want specified healthcare treatments, including tube feeding or intravenous hydration, even if she died as a result; or that it would result in severe brain damage and poor functional status. She appointed her partner Teresa as her designated healthcare representative.
Amy was admitted to a nursing home where staff noted that, despite assistance from dietetic staff, her nutritional intake was poor and that she was losing weight and at increased risk of developing a pressure sore. They asked the General Practitioner, Dr O’Neill, if he could advise Teresa, as Amy’s designated healthcare representative, to allow tube feeding.
Dr O’Neill reviewed the advance healthcare directive and noted that it was clear about the healthcare treatments to be refused and about the circumstances in which these refusals were to apply. He informed staff that the refusal of tube feeding was legally binding, even if it resulted in Amy’s decline and death, and that it wasn’t possible for anyone, including Teresa, to override Amy’s clear will and preferences as outlined in her advance healthcare directive. He also noted the importance of providing basic care, including whatever oral nutrition and hydration that Amy could tolerate, and measures to minimise the risk of pressure sores.
Comment: This vignette shows that a person can make a legally binding refusal of life-sustaining treatment in an advance healthcare directive and that in order to do so, the directive-maker must expressly state that the refusal of treatment in the advance healthcare directive is to apply even if their life is at risk. It also shows that basic care cannot be refused and gives an example of what constitutes basic care in the situation in question.