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Clinically Assisted Nutrition and Hydration

News and presentations from today's conference focusing on recent developments and implementing the December 2018 BMA/RCP guidance on Clinically Assisted Nutrition and Hydration.

Implementing the BMA/RCP Guideline in Clinical Practice
Prof Lynne Turner-Stokes OBE
, Consultant in Rehabilitation Medicine, Northwick Park NHS Trust Director, Regional Rehabilitation Unit and Dunhill Chair of Rehabilitation,Kings College London. Advisory Group Member, Clinically-assisted nutrition and hydration (CANH) and adults who lack the capacity to consent Guidance for decision-making in England and Wales.
Pre-Conference Abstract:
This presentation will address the implementation of the BMA/ RCP guidance in clinical practice.

  • We start with some background to the Mental Capacity Act and the responsibilities of both clinical staff and patient’s families when making decisions
  • We consider the two sets of guidance form the BMA and RCP and ask what is unusual about clinically assisted nutrition and hydration (CANH) and about patients in prolonged disorders of consciousness
  • We explore some of the base principles and the approach to best interests decision-making with respect to both CANH and other life sustaining treatments
  • We outline the key steps and the process of proportionate external review
  • We discuss some of the challenges to both clinicians and commissioners in the implementation to this guidance

Best Interests Care Planning
Starting conversations around best interests and care planning at an early stage
Dr Jonathan Hinchliffe, 
Principal Clinical Psychologist & MCA/DOLS Manager, Royal Hospital for Neuro-disability
Pre-Conference Abstract:
The talk will initially consider the nature of decision making around nutrition and hydration. It will emphasise the importance of starting conversations at an early stages, and consider how to develop and monitor care plans across an array of conditions. The talk will include a brief exploration of the uncertainty surrounding diagnosis and prognosis, and ways to support individuals to understand these complexities. Finally, the talk will consider the process of supporting families, as well as engaging individuals in best interests meetings, with appropriate documentation. 
Full PowerPoint Presentation 

Decision making and best interests: Reaching the decision that is right for the patient
Dr John Chisholm CBE

Medical Ethics Committee Chair, British Medical Association. Chair, Core Group Clinically-assisted nutrition and hydration (CANH) and adults who lack the capacity to consent Guidance for decision-making in England and
Wales

Prolonged Disorders of Consciousness and Decision-Making about Life-Sustaining Treatments
Professor Celia Kitzinger
, Co-Director, the Coma and Disorders of Consciousness Research Centre, Honorary Professor, School of Law and Politics, Cardiff University
Pre Conference Abstract:
Both law (in particular the Mental Capacity Act 2005) and professional guidance (from the Royal College of Physicians, the British Medical Association and the Royal College of Physicians) are clear about what is required for best interests decision making about clinically assisted nutrition and hydration.  Yet in practice, treatment is often provided 'by default', there is no nominated 'decision-maker', family and friends are not consulted about patients' values, wishes, feelings and beliefs,  and clinicians own undeclared conscientious objection to treatment-withdrawal (and/or the institutional 'ethos' of the care home or rehab centre)  leads to continuing treatment without reference the best interests of the patient - sometimes for decades.  Drawing on three case studies (one from her own family experience), Celia Kitzinger talks about the gap between law and guidance on the one hand, and on-the-ground practice on the other, and asks what can be done to remedy the deficit in person-centred care.
Full PowerPoint Presentation

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