Early Day Motion 2012: Kerrie Wooltorton and the mental capacity act

I have been following with great interest discussions regarding the tragic case of Kerrie Wooltorton, in particular comments at Dr Grumble and The Witch Doctor. There is much debate concerning the legal and ethical status of the decisions made by the medical team responsible for her care; indeed, Witch Doctor comments that this case "has opened up a whole supermarket of cans containing legal, ethical, clinical and moral worms."

Googling "Kerrie Wooltorton" brings up close to 9000 hits. In the course of my reading, I have learnt that in circumstances where a patient presents in a conscious state, the presence of an advance directive could be considered irrelevant. The general legal consensus seems to be that Kerrie Wooltorton's doctors acted lawfully when they withheld treatment.

Reading the multitude of opinions on this case leaves me no closer to a conclusion that I am comfortable with. I am ashamed to say that I am relieved that I have the luxury to read about this case on the internet and not be faced with it in clinical practice. It is also reassuring that senior doctors, like Dr Grumble and Witch Doctor, agree that this situation is not black and white. The fact remains that I still do not know what I would do if faced with a similar situation. Of course, at this stage of my career it is somewhat easier: there is a consultant at the other end of the phone (or increasingly, on site providing clinical service - but that's another argument). As a junior doctor, I would expect guidance from the boss. I would expect that their guidance would be legally, morally and ethically sound and be in the best interests of our patient. I would expect to feel reassured and confident that I was about to embark on the best course of action.

Despite all that has been said and written about this case, I am still yet to be convinced that there was a "right answer." I hope that this becomes clearer to me before I become a consultant. Competence seems to be the key. And deciding whether someone is competent or not is not always straightforward. Whilst I understand that in theory mental illness may not prevent an individual from being competent, when the consequence of agreeing that the individual is competent include allowing the individual to die, I think I would at the very least want competence to be assessed by a psychiatrist.

Interestingly, an Early Day Motion has been filed regarding the mental capacity act in this case. Sadly, EDMs are rarely debated. So, it is likely that if a similar situation occurs, the doctors will again be asked to make an impossible decision.