{"id":833,"date":"2009-10-01T17:20:45","date_gmt":"2009-10-01T16:20:45","guid":{"rendered":"https:\/\/blogs.bmj.com\/bmj\/?p=833"},"modified":"2009-10-07T10:24:46","modified_gmt":"2009-10-07T09:24:46","slug":"sheila-mclean-on-advance-directives-and-the-case-of-kerrie-wooltorton","status":"publish","type":"post","link":"https:\/\/blogs.bmj.com\/bmj\/2009\/10\/01\/sheila-mclean-on-advance-directives-and-the-case-of-kerrie-wooltorton\/","title":{"rendered":"Sheila McLean on advance directives and the case of Kerrie Wooltorton"},"content":{"rendered":"<p><img loading=\"lazy\" decoding=\"async\" src=\"http:\/\/www.bmj.com\/columns\/icons\/sheila_mclean.jpg\" alt=\"Sheila McLean\" width=\"162\" height=\"110\" align=\"left\" \/><br \/>\nThe inquest into the death of Kerrie Wooltorton in 2007 has focused <a title=\"Daily Telegraph website\" href=\"http:\/\/www.telegraph.co.uk\/health\/6248646\/Suicide-woman-allowed-to-die-because-doctors-feared-saving-her-would-be-assault.html\" target=\"_blank\">some media attention<\/a> on advance decisions (directives), or so-called \u2018living wills&#8217;. While undoubtedly a tragic case, however, it is worth unpicking what we can actually learn from it.<!--more--><\/p>\n<p>Ms Wooltorton had apparently drunk anti-freeze on up to nine previous occasions, but had nonetheless accepted life-saving treatment.\u00a0\u00a0 To complicate matters, she was also said to be suffering from an \u2018untreatable&#8217; emotionally unstable personality disorder.\u00a0\u00a0 The final twist in this complex story was that a few days before her death she had drafted an advance statement indicating that she did not wish to be treated should the same circumstances arise in the future, even if she called an ambulance.\u00a0\u00a0\u00a0 Rather than being treated, she wanted to die in a situation where she was not alone and comfort care was available.\u00a0\u00a0 The advance directive was presented by Ms Wooltorton on admission to hospital and when she was still conscious.\u00a0\u00a0 Presumably this decision was executed in line with the legislative requirements and was, therefore, valid on its face.<\/p>\n<p>What can be drawn from this case?\u00a0\u00a0 First, even although Ms Wooltorton had previously accepted life-saving treatment following ingestion of anti-freeze, no legal inference can necessarily be drawn from this that she would have accepted it on the final occasion.\u00a0\u00a0 In other words, even if she had \u2018changed her mind&#8217; in the past, objectively she had the right to make a different decision on this occasion.\u00a0\u00a0 Second, as she was able to make a contemporaneous refusal of treatment on admission to the hospital, her doctors were legally unable to provide it.\u00a0 This, of course, depends on the presumption that she was legally competent at the time of the refusal.\u00a0\u00a0 The fact that she apparently had some form of personality disorder is not in itself persuasive evidence that she was not competent.\u00a0\u00a0 It is well established in law that even the presence of mental illness is not a bar to the presumption of competence.\u00a0\u00a0 The Mental Capacity Act 2005 (which does not apply to Scotland) specifically indicates that a person is legally incompetent if s\/he is unable to understand the information relevant to the decision, to retain that information, to use or weigh that information as part of the process of making the decision, or to communicate his or her decision (whether by talking, using sign language or any other means).\u00a0\u00a0 The observation of Ms Wooltorton&#8217;s treating physician, which it must be said he took great pains to have verified, was that Ms Wooltorton did not fail the competence test outlined in the Act, and was steadfast in her wish to reject treatment.<\/p>\n<p>Assuming, therefore, that Ms Wooltorton was indeed legally competent, the existence of the advance directive was essentially irrelevant.\u00a0 Although some media outlets have reported this case as one that is directly related to the advance directive, in fact it is in essence only about a straightforward refusal of consent by a competent adult person.\u00a0\u00a0 Simply put, a doctor who imposes treatment in the face of a competent refusal would be guilty of assaulting the patient.\u00a0\u00a0 However dreadful it must be for healthcare professionals to watch a person who could be saved die for want of available treatment, they have no alternative but to do so.\u00a0\u00a0 The recent legislation makes no change to this position.\u00a0\u00a0 Of course, had Ms Wooltorton arrived at hospital in an unconscious state and with no advance directive, the chances are that doctors would have done everything in their power to save her and this would have been justified by the legal doctrine of necessity.\u00a0\u00a0 Had she arrived unconscious but with an applicable advance directive, no attempt at treatment would have been lawful.\u00a0 However, neither of these situations arose.\u00a0\u00a0 Ms Wooltorton was adult, competent and able at the relevant time to reject treatment.\u00a0\u00a0 This was her right and, as such, had to be respected.<\/p>\n<p><em>Professor Sheila A M McLean LLB. MLitt, PhD, LLD, LLD, FRSE, FRCGP, F Med Sci, FRCP(Edin), FRSA<br \/>\nInternational Bar Association Professor of Law and Ethics in Medicine<br \/>\nDirector, Institute of Law and Ethics in Medicine at the University of Glasgow<\/em><\/p>\n","protected":false},"excerpt":{"rendered":"<p>The inquest into the death of Kerrie Wooltorton in 2007 has focused some media attention on advance decisions (directives), or so-called \u2018living wills&#8217;. While undoubtedly a tragic case, however, it [&#8230;]<\/p>\n<p><a class=\"btn btn-secondary understrap-read-more-link\" href=\"https:\/\/blogs.bmj.com\/bmj\/2009\/10\/01\/sheila-mclean-on-advance-directives-and-the-case-of-kerrie-wooltorton\/\">More&#8230;<\/a><\/p>\n","protected":false},"author":1,"featured_media":0,"comment_status":"open","ping_status":"closed","sticky":false,"template":"","format":"standard","meta":{"footnotes":""},"categories":[223],"tags":[1449,1450],"class_list":["post-833","post","type-post","status-publish","format-standard","hentry","category-guest-bloggers","tag-advance-directives","tag-living-wills"],"yoast_head":"<!-- This site is optimized with the Yoast SEO plugin v27.6 - https:\/\/yoast.com\/product\/yoast-seo-wordpress\/ -->\n<title>Sheila McLean on advance directives and the case of Kerrie Wooltorton - The BMJ<\/title>\n<meta name=\"robots\" content=\"index, follow, max-snippet:-1, max-image-preview:large, max-video-preview:-1\" \/>\n<link rel=\"canonical\" href=\"https:\/\/blogs.bmj.com\/bmj\/2009\/10\/01\/sheila-mclean-on-advance-directives-and-the-case-of-kerrie-wooltorton\/\" \/>\n<meta property=\"og:locale\" content=\"en_US\" \/>\n<meta property=\"og:type\" content=\"article\" \/>\n<meta property=\"og:title\" content=\"Sheila McLean on advance directives and the case of Kerrie Wooltorton - The BMJ\" \/>\n<meta property=\"og:description\" content=\"The inquest into the death of Kerrie Wooltorton in 2007 has focused some media attention on advance decisions (directives), or so-called \u2018living wills&#8217;. 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