If I [a patient] only had the chance to tell my family carer, and if 999 paramedics don't believe my family carer – then how does that work for me!

mike stone 12/01/19

Mysteriously, I clicked on 'post' and it posted the title, but not the text of my piece - here goes, this is the text which should have appeared:

mike stone 12/01/19

Still the text hasn't appeared - I'm confused! I'll try posting the piece in 2 sections (perhaps it is too long) but I'll also try attaching it as a PDF here: so Part 1 is

Associated files and links:

mike stone 12/01/19

Can't get the piece to post as text - I'm still not sure why? You can read it by downloading the PDF.

mike stone 14/01/19

Gary Rycroft says at about 27 minutes, a couple of things which are flawed [and therefore unhelpful, in the context of the existing very poor understanding of the MCA].

First, Gary says that an LPA enables the person you've chosen (your welfare attorney) to 'advocate on your behalf'. No – you've appointed and empowered the attorney to make the best-interests decisions, so 'other people might be 'advocating' to the attorney': the attorney doesn't need to 'advocate' to anybody, in the context of interventions 'which are being offered' (and most of the broadcast, is discussing CPR, which 'is attempted by default'). You 'advocate to' the person who will be making the decision – and the welfare attorney IS the person who would be making the best-interests decision.

Gary then states that Advance Decisions and 'advance statements' are 'telling attorneys what to say on your behalf'. Well – the wording is between wrong and confusing. An Advance Decision, isn't 'directed at your attorney': an ADRT is 'an instruction for EVERYONE to follow'. Your attorney is in exactly the same situation as everyone else, with respect to an ADRT: the ADRT amounts to a DIRECT ORDER from the patient. As for 'advance statements': Gary had previously discussed those in the context of things which are not treatments – such as the music you might prefer to be playing in your room. But the term 'advance statement' can also be applied to any written expression about a treatment which is less absolute than 'I refuse': an Advance Decision is 'My DECISION is [to refuse] …' and if you are instead writing the equivalent of 'My PREFERENCE is …' then that is an 'advance statement'. So 'I never drink coffee – I only drink tea' is the sort of information (but for medical interventions) which an ADRT is conveying, whereas 'I usually prefer tea, given the choice between tea and coffee' would be 'an advance statement'. In the context of treatments, an 'advance statement' IS something the attorney would need to consider during best-interests decision-making.

Expressed differently [and this is how I prefer to express it]:

An Advance Decision removes the need for any best-interests decision-making to take place: in fact, the Advance Decision legally REQUIRES that no best-interests decision-making should take place, if the ADRT is applicable.

While I'm posting this: I think it WOULD BE HELPFUL, if 'the NHS' developed and employed the 'MCA 4(7) Form' that I've rough-drafted at:


mike stone 07/08/19

I was drawn back to the BBC Radio 4 broadcast, about how people can try to make sure that their decisions and preferences as to how they should die are respected by healthcare professionals, when during a phone call with a doctor it was suggested [apparently correctly, it turns out] that I had inferred something about what West Midlands Ambulance Service is telling its paramedics, which isn't the case.

I've checked on this - I did conclude something from the broadcast, that isn't correct.

I have transcribed sections of the broadcast in the PDF - if anyone listens to the entire broadcast, or simply reads the transcribed sections, I would be interested in their posts as to whether they would have drawn the same conclusion as I did.

There is also something in the broadcast, which definitely needs further discussion (I don't discuss it in the PDF - I have discussed it in some previous pieces, and I might write a new piece about this) - it is what the expert paramedic said here (this is a transcription from the broadcast):

Joan Bakewell then talks:

So what can you tell the listeners to help them decide when they should not call an ambulance, and when they should?

Robert Cole answers:

They could have cancelled the ambulance, they could have called a doctor, they could have waited [a word I couldn’t make out – it sounded like ‘til’] not call us at all – I don’t want people to not call us and allow someone to suffer but I want people just to think [very short pause] I think the answer here goes back to your conversation earlier Joan about advance care planning.

Associated files and links: