Legal risk to life-saving doctors

Doctors who save patients' lives against their wishes could open themselves up to legal action, a leading emergency specialist says.

Professor Mike Ardagh, from the Christchurch School of Medicine and Health Sciences, told the Australasian College of Emergency Medicine in Wellington yesterday that doctors and lawyers clashed at times over a patient's right to make decisions about their treatment.

A student recently replicated a landmark study published 13 years ago in the British Medical Journal, in which doctors, ethicists and lawyers were asked to consider two cases in which emergency staff treated patients against their will.

The first case involved a 46-year-old alcoholic who fell down concrete stairs and cracked his skull. He refused treatment but was brought back to the emergency department twice by police before finally agreeing to stay.

The second was a 30-year-old man brought in after a suicide attempt. After being given the first dose of an antidote for his overdose, he woke briefly and told staff: "Leave me alone, I want to die", before again lapsing into a coma.

Staff pumped his stomach anyway, he recovered and was discharged from hospital after three weeks on anti-depressants, expressing regret for his suicide attempt and his gratitude to staff for saving his life.

Doctors and philosophers agreed staff would have been "negligent" not to treat the patients.

However, both the British and Kiwi lawyers in the study disagreed, saying medical staff had acted "illegally" by assuming patients were "not competent".

Patients would be able to "claim damages" if their life was saved against their consent. The New Zealand lawyer said treating someone against their clearly expressed will was "assault".

Professor Ardagh said he believed the lawyers were wrong, but doctors were also to blame for not communicating the ethical basis for their actions.

Under the Health and Disability Commission's code of patient rights, doctors can treat someone without consent if it is a matter of urgency (if the patient is unconscious), or if they believe the patient would give consent if competent. "This doesn't give us the right to do anything we want, of course ... and maybe I'm being naive, but I believe good application of ethics - the clinical issues clearly stated - will bring the lawyers in behind us."

Professor Ardagh said doctors should protect themselves from potential legal action by recording clearly that the patient's judgment was impaired, the patient was at risk, and their belief that the patient would have given permission for the treatment if competent.

- © Fairfax NZ News