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Clinically Assisted Nutrition and Hydration

Lucy Watts MBELucy Watts MBE

News and updates from today's conference focusing on recent developments and implementing the December 2018 BMA/RCP guidance on Clinically Assisted Nutrition and Hydration, and chaired by Dr John Chisholm CBE, Medical Ethics Committee Chair, British Medical Association

Putting personal experience first
Lucy Watts MBE,
Ambassador & Young Avenger, Together for Short Lives, People in Partnership Steering Group Member, Hospice UK
Lucy discusses her life whilst being a long-term dependent on Clinically Assisted Nutrition and Hydration, in the form of daily intravenous feeding and fluids, as well as what steps she’s had to take to ensure that these would be withdrawn at an appropriate time, as outlined in her Advance Decision, and talks about her experiences of Advance Care Planning and how important these conversations - and the plans themselves - are for patients like herself. 
Lucy, speaking at the conference this morning said "My life isn't limited, what good is healthcare if it doesn't allow you to live? I have an amazing life thanks to artificial nutrition. My team of professionals get it right, my medication is fitted into my life - not my life fitted around my medication. CANH has kept me alive for a long time and I have good quality of life. When discussing my advanced care plan I was asked what I want, it's as much about living as it is about dying. It's better to be open and talk about end of life, it gives me more control, and it takes the pressure off my family. Having my documents with me is very important so everyone knows my Advance Care Plan. There is a huge difference between being alive and living. People sometimes feel they can't talk about end of life, as professionals you need to give them the permission, tools, language and skill to have theses conversations".
"You need to understand how much you're willing to go through to have a shot at being aive and what level of being alive is tolerable to you".

Full PowerPoint Presentation

Decision making and best interests: Reaching the decision that is right for the patient
Dr Chris Danbury,
Consultant in Anaesthetics and Intensive Care Medicine, Royal Berkshire Hospital, Visiting Fellow in Health Law, University of Reading Chair, Legal and Ethical Policy Unit, Faculty of Intensive Care Medicine
Disputes are common in medicine, particularly at the end of life. Dr Danbury discussed the theoretical framework for why that should be, and provides a potential structure to resolve disagreements.
Chris said this morning "70% of ICU staff memebrs have reported conflicts in intensive care - staff/staff and staff/family. Families, ICU physicians and nurses report conflicts in up to 80% of patients requiring a treatment-limitation decision. Few patients die on ICU unexpectedly. 70% of patients who die on ICU have some form of limitation of treatment". 
Full PowerPoint Presentation

EXTENDED SESSION: Legal Principles
Alex Ruck Keene, 
Barrister, 39 Essex Chambers
Pre-Conference Abstract
Alex Ruck Keene will explain the changing legal landscape within with decisions relating to CANH are taken in England and Wales, and explain the legal framework around these decisions now that the Supreme Court in NHS Trust v Y has confirmed that the endorsement of the court is not required where a rigorous decision-making process has been followed and there is agreement as to what is in the person’s best interests.
Full PowerPoint Presentation

EXTENDED SESSION: Implementing the BMA/RCP Guideline in Clinical Practice
Dr Shuli Levy
, Consultant Geriatrician and General Physician, Imperial College Healthcare NHS Trust
Pre-Conference Abstract 
Decisions around clinically assisted nutrition and hydration (CANH) can be extremely challenging and complex for the multidisciplinary team, for patients and those around them. At worst, they can be fraught with conflict and uncertainty, or left unreviewed for years.  The new BMA/RCP guidelines provides, for the first time, a systematic and reproducible approach to decision making, in line with the mental capacity act, GMC good practice guidelines and existing case law. Whilst recognising that every case is unique, the guidelines provides a framework for considering patients according to their likely prognosis and trajectory and a structure for approaching best interest decision making in a timely manner. The guidelines deal with a range of particularly challenging areas, such as people with advanced dementia, clinicians with a conscientious objection and managing conflict in decision making. This talk will use clinical cases to illustrate key areas of the guidelines, with a particular focus on degenerative and declining conditions, dealing with conflict and the role of regular best interest meetings.
Full PowerPoint Presentation

Related Events

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Wednesday 10 July 2019, Manchester

Effective Nurse Prescribing in End of Life Care
Wednesday 10 July 2019, Manchester

Caldicott Principles & Information Sharing in End of Life Care
Friday 12 July 2019, London

Improving End of Life Care for People with Dementia
Friday 13 September 2019, London

10 May 2019


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