Update to main text para 1.25 fn3, page 18: 

For guidance on consent see the Royal College of Surgeons’ Consent: Supported Decision-Making – a good practice guide: which notes:

‘The surgeon discussing treatment with the patient should be suitably trained and qualified to provide the treatment in question and have sufficient knowledge of the associated risks and complications, as well as any alternative treatments available for the patient’s condition’

Update to main text para 13.13¸ page 406

In his Oxford speech[1], Baker J contrasted diagnosis of brainstem activity, which can be done with neurological testing, with the extreme difficulty of diagnosing a patient’s level of consciousness, commenting:

‘The principal potential weakness is that there are no definitive criteria of awareness so that such assessments depend on judgment and interpretation which may be challenging even for the professionals experienced in carrying out the assessments. Furthermore, differences may arise between the observations professionals carrying out assessments and those of family members who, while they may lack the objectivity which the professional possesses, have spent far more time with the patient and have greater experience of interpreting their behaviour.’

Update to main text para 13.10, page 397

There has been some debate[1] as to the position where the provision of clinically assisted artificial nutrition and hydration is clearly covered by a valid and applicable advance decision to refuse treatment or has been properly delegated by a Lasting Power of Attorney[2].

Update to main text para 10.20, page 324

Re CA (Natural Delivery or Caesarean Section) [2016] EWCOP 51, 8.12.2016

In another application made very late in the pregnancy, Baker J lamented the applicant Trust’s failure to follow the FG guidelines which meant there was very limited time for the Official Solicitor to make proper enquiries on behalf of the woman concerned. Even though the application was made less than a fortnight before CA was due to give birth, the Judge refused the immediate order sought, and instead granted a four day adjournment to enable the Official Solicitor to visit CA and carry out some limited investigations. He expressed the hope that those responsible for managing the case within the Trust would carry out a proper investigation as to the causes of the delay, and went on: “Hereafter, all NHS Trusts must ensure that their clinicians, administrators and lawyers are fully aware of, and comply with, the important guidance given by Keehan J in respect of applications of this sort.” The Judge was also unhappy that CA’s medical records were not available to the Court.