Making decisions about feeding tubes for vegetative & minimally conscious patients: law, ethics and professional guidance

Professor Jenny Kitzinger was our October Speaker and she talked about decision making in tube fed patients who have prolonged disorders of consciousness – law ethics and professional guidance. She highlighted the key principles of best interest decision making in these patients who lack capacity and the risks involved in treating these individuals without best interest being established. For example, signing a monthly prescription for tube feeding (established as a medical treatment in law by the Tony Bland case) could constitute an assault – a surprise to many of the GPs in the audience! The GPs were also somewhat surprised to find that in the community they are the clinically responsible decision-maker for their patient, with all the responsibility that entails. The new guidelines from the Royal College/BMA should be read by all prescribers/decision-makers. Changes in the law now mean that withdrawal of tube feeding no longer needs go to court – so long as all parties agree.

There was lively discussion about ‘best interest’ meetings, with some strong views expressed and this led to discussion about what preparations the audience had made to ensure that family/friends would be aware of their own wishes about how they would wish to be managed should brain injury occur. A show of hands demonstrated that very few members of the audience had prepared either an Advanced Care Directive or a Power of Attorney and even fewer had both.

A very pleasant and enjoyable evening was had by all at our first meeting at The Croydon Day Hospital where we were very well looked after in very conducive surroundings.

Peter Boffa

A copy of Professor Kitzinger’s slides are available from the Members’ Only Area.

Professor Kitzinger’s Biog.

Professor Jenny Kitzinger is co-director of Cardiff University’s ‘Coma and Disorders of Consciousness Research Centre’ which specialises in examining legal, social and ethical aspects of how we treat such patients (see www.cdoc.org.uk; Twitter). Jenny served on the Royal College of Physicians’ working party on prolonged disorders of consciousness and contributed to the BMA/RCP guidance on decision-making about Clinically Assisted Nutrition and Hydration. Her research, conducted with her colleague (and sister), Professor Celia Kitzinger, has been widely published in journals such as The Journal of Medical Ethics, the BMJ, and Sociology of Health and Illness. This research has also been translated into a multi-media resource for families (see www.healthtalk.org/peoples-experiences/nerves-brain) and online training for clinicians (see CDOCTraining.org.uk)