The Royal College of Physicians (RCP) has published updated guidelines on the diagnosis, assessment and management of patients with prolonged disorders of consciousness.
The guidance, which is endorsed or supported by 15 health bodies, includes advice on the new legal situation after a 2018 court ruled saying it is no longer necessary to apply to a court for the approval to withdraw clinically assisted nutrition and hydration (CANH) provided certain conditions are met.
Legally, in the absence of a valid and applicable advance decision to refuse treatment or a lasting power of attorney for health and welfare appointed by the patient prior to losing capacity, no one person can make decisions on behalf of the patient – this includes the patient’s family, friends or carers. In practice, this means that the senior clinician in charge of the patient’s care is responsible for determining whether treatment should be started, continued or stopped. The guidelines offer advice and resources to support this decision-making process.
Commenting on the guidelines, Professor Jenny Kitzinger, co-director of the Coma and Disorders of Consciousness Research Centre, Cardiff University, said: “Many patients in prolonged vegetative or minimally conscious states are lost in the system, sometimes for years, or even decades, without access to reassessment or any review of whether or not life-sustaining treatment continues to be in their best interests."
“These guidelines make it clear that patients should not be treated by default and that it is up to the professionals to ensure best interests reviews take place on a regular basis. Families should be asked about what the patient was like, what they might have wanted in their current situation, and should never have to be the ones to initiate discussion about continuing or stopping treatment,” she said.
