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51 Med. Sci. & L. 1 (2011)

handle is hein.journals/mdsclw51 and id is 1 raw text is: Presentation Proceedings of the Sixth Northern Region Paediatric Colloquium Mandy Abbott MBBS MRCPsych* and Corrine Reid MBBS MRCPsycht *CAMHS, 1st Floor Benton House 136, Sandyford Road, Newcastle upon Tyne NE2 1QE; tCAMHS, Newcastle upon Tyne, UK Correspondence: Mandy Abbott. Email: mandyabbott@gmail.com Abstract It is apparent that the practice of medicine in today's society can often raise difficult legal and ethical dilemmas. With this in mind, senior figures from the medical, legal and theological professions have met on a biennial basis in order to discuss anonymised case material of such a nature. This provides a valuable forum in which to discuss such dilemmas, enabling the sharing of knowledge and experience from which we all can learn. To this end, we report the proceedings of the 'Sixth Northern Region Paediatric Colloquium', which are now the third set of proceedings to be published. Med Sci Law 2011; 51: 1-4. DOI: 10.1258/msi.2010.010044 Introduction The Colloquium was held in March 2009 at Walkergate Park Hospital, Newcastle upon Tyne, UK. It was attended by senior clinicians, legal professionals and religious leaders from the local community. Four anonymised cases were presented, all of which centred on a medico-legal and/or ethical dilemma. These cases are described and key points arising from the subsequent discussion are presented. Case 1 Helen is a 22-year-old psychiatry inpatient with a diagnosis of schizophrenia. She is pregnant. She has refused any medical assessment or treatment apart from allowing an obstetrician to perform an abdominal examination. From this she was judged to be within 4-6 weeks of delivery. Helen denies that she is pregnant declaring that there 'may be a baby' but it is not hers. The consultant psychiatrist considers that Helen lacks capacity to make decisions in relation to her impending labour. It is also thought that a negative outcome for her fetus would make Helen's schizophrenia more resistant to treatment and result in significant detriment to her long-term health. The obstetricians are concerned that Helen receives medical treatment that is in her best interests and that a caesarean section is likely to be needed. They are also concerned about the extent to which they are permitted to take into account the needs of the unborn baby. In this case the National Health Service Trust applied to the Court for declarations that Helen lacked capacity to make decisions in relation to her impending delivery and that it was in Helen's best interests that a caesarean section be performed. This case raised two main questions: * If Helen had capacity to make decisions in relation to her impending delivery, could she refuse medical treatment including a caesarean section? Would she need to have good reason? Should weight be given to the interests of the unborn child? Where would this leave her treating doctors? * If Helen lacked capacity to make decisions in relation to her impending labour, how should the court approach the best interests decision and again what weight would be given to the interests of the unborn child? Prior to the discussion the legal approach was outlined. Capacity to consent and 'best interests' are explained by the following statements: * In general it is a criminal and tortuous assault to perform physically invasive medical treatment, however minimal the invasion may be, without the patient's consent; * Every person is presumed to have the capacity to consent to or to refuse medical treatment unless and until that presumption is rebutted; * A competent woman who has the capacity to decide may for religious reasons, other reasons, for rational or irrational reasons or for no reason at all, choose not to have medical intervention, even though the consequences may be the death or serious handicap of the child she bears, or her own death; * If therefore the competent mother refuses to have the medical intervention, the doctors may not lawfully do more than attempt to persuade her. If that persuasion is unsuccessful, there are no further steps towards medical intervention to be taken; * Best interests are not limited to medical best interests but include emotional and all other welfare issues. The Court attempts to reach an objective view of best interests in the light of all the relevant circumstances and evidence avail- able to it. The effects of these legal approaches are as follows: Medicine, Science and the Law 2011; 51: 1 -4

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