This principle approved and developed by Dame Elizabeth Buttler-Sloss. A mentally competent patient has the right to refuse consent to medical treatment. In this case, Dr Walter Smith made advance directive before his condition deteriorated about refuse medical treatment, when the refusal will mean death. I accept that he had the capacity when the directive was written; however, Dr Smith has no capacity now. Since the advance directive was made when he has the capacity to decide, although the principle of sanctity of life is not absolute, as the right of self-determination means the right to live his own life how he wishes, even if it will damage health or lead to premature death. Doctors have to make consideration to what the patient capacity to decide to decide at the time the decision was made. While the decision of the patient remains paramount.
In 1990, Doctor Smith made his living will to make his family know his wishes regarding his treatment when he will no longer capable to make decision. His wishes was recorded, but unfortunately in early nineties there was no statutory authority for living wills.
The guidance adds that cardiopulmonary resuscitation (CPR) has a low success rate, especially for patients with serious conditions who are in poor general health. If used inappropriately, it may do more harm than good by prolonging the dying process and pain or suffering of serious ill patient, in a manner which could seen as degrading and undignified.
For example, if a patient is at the end-stage of an incurable illness and imminent attempts to resuscitate them are likely to be futile and not in the patient’s best interest.
Dr Smith capacity has been reduced by the impairment of mental illness. This affects his ability to retain information, which means he is unable to use the information to weigh it in the balance to make decision. Dr Walter Smith is capable of making decision, he was diagnosed with Huntington disease in (1990) and before 1990 Dr Walter was capable and he his nurturing his medical career.
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After Re B case the authoritative government now make statement s, that living will can legally effective, if advance directive is properly drafted and if applies to the situation which arise. Lord Donaldson of Lymington M.R, in Re T. (Adult: Refusal of treatment) [1993] Fam.95.
Returning to the matter of Re B capacity, which occupied so much of the president’s judgement, it is arguable the amount of attention directed to this issue is significant in itself.
It may thought to give the lie to some of the more hard-edged obiter dicta from earlier case in which it had been asserted that the competent patients are entitled to refuse medical treatment (including life saving treatment) for no reason at all.
Admittedly, near the beginning of her judgement, the president repeated a dictum just this effect from her own previous judgement in Re MB. This was immediately followed, however, Dr Walter Smith reasons for wishing to discontinue ventilation and refuse treatment in this case and his advance directive, apparently should stand as a precondition for finding him competent.
References:-
1. (1993) 113 family law
2.Family law reports 426(*19907)at 437(Buttler Sloss -LJ)
3.Aniieapples project
4. LLB News.