Healthcare Professionals
Emergency medical situations and the doctrine of necessity
Deirdre is an older woman who is admitted to hospital with a possible perforated bowel. At this time, she is alert and lucid, although in considerable pain. The surgeon Dr Stewart explains to her that, depending on the results of investigations, an operation might be indicated, and quickly explains the benefits and risks of an operation. Deirdre seems to understand this and agrees to surgery if required.
Tests confirm the bowel perforation. When Dr Stewart comes to explain this and review her, Deirdre is significantly worse. She has fever, reduced blood pressure, and is delirious. When Dr Stewart explains that it was now clear that she needs urgent surgery to save her life, she doesn’t seem to understand and mutters “leave me alone. Go away” several times. Dr Stewart concludes that Deirdre now lacks capacity to make her own decision to give or withhold consent to surgery. Considering that the surgery cannot be deferred and would be lifesaving, Dr Stewart decides to proceed with the operation.
Comment: This vignette shows the operation of the doctrine of necessity in an emergency situation where the relevant person lacks capacity. Emergency situations are those in which immediate or urgent action by healthcare professionals is needed to avoid significant harm, injury, or death to a person. Where the relevant person requires immediate treatment and lacks capacity to make a decision about that treatment, a healthcare professional may provide the treatment indicated, without first obtaining the relevant person’s consent. A healthcare professional should not provide treatment other than that immediately necessary in the circumstances of the emergency.