Mike Stone's PDFs: I hope to post various PDFs about EoL/MCA/CPR in this thread

mike stone 03/06/17 Dignity Champions forum

I have been somewhat at a loss, since in its previous re-vamp DiC lost its ability to upload files. The great advantage of the DiC website - apart from its wide readership - is that it is 100% open access with respect to reading and downloading (unlike, for example, DiA on Facebook).

I will be posting my shorter pieces here, but not singly: and I am starting by posting (all feedback very welcome) 5 short PDFs which I have joined together [it is easy to 'see the joins']. They are short, so anyone interested can just take a look - the title of the final one is a little mysterious, and in fact it analyses the concepts of 'expected and unexpected death' for known EoL patients who are at home (the conclusion being that 'unexpected EoL death' is a deeply unsatisfactory idea/label and that you cannot even in theory sensibly use ONLY 'expected' and 'unexpected' death for end-of-life at home).

The pieces are, in order, titled:

A 'beautiful analysis' of the Mental Capacity Act

Decision-Makers and the MCA

Some Points about CPR

There is a problem with Advance Decisions

An End-of-Life Timeline with an emphasis on Death at Home

Associated files and links:

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mike stone 05/06/17

The attached PDF contains in order:

A Little More About ‘Talking about Death’

Things Change

The Consequences of Role-Induced Perception

I Lied

All four pieces are very-much ‘on a shared theme’ so if you read the PDF, I suggest you just read from the start onwards. I will point out that there is something in the pieces, which means you really DO NEED to read ‘Things Change’ BEFORE you look at ‘I Lied’. If people do read 'Things Change' and afterwards read 'I Lied', I would be interested in any feedback - 'does it make the point' ?

Associated files and links:

mike stone 06/06/17

I wrote a very short piece 'The Fossil Tooth of the MCA' some time ago, highlighting the 'conceptual importance' of section 25(4)(c) of the Mental Capacity Act.

Since then Mr Justice Charles has ruled in the Briggs case, and I have written a foreword to 'Fossil Tooth' [longer, in fact, than Fossil Tooth itself].

Mr Justice Charles has shed some light on best-interests decision-making during incapacity - supporting a position previously adopted by Mr Justice Hayden, and which was in line with my own analysis of the MCA - but we do need a lot more clarification of some parts of the MCA. Notably, we need to sort out the problem with 'verbal refusals of life-sustaining treatments and why ADRTs refusing life-sustaining treatments need to be written to be valid', a problem I have analysed in 'There is a problem with Advance Decisions' which can be found in the PDF you can download from my first post in this series.

Associated files and links:

mike stone 19/06/17

The attached PDF is 3 pieces joined together. Two of them stem from some recent discussions I’ve had about ‘grief and grief disorders’. The first piece

The ‘Immediate Shock’ of Bereavement

applies the idea of ‘psychological first aid’ to Home EoL Death and ‘unexpected’ deaths: current behaviour is actually more ‘psychological assault’ than ‘psychological first aid’ following many entirely natural deaths.

My second piece

A Personal Reflection about my own dubious healthcare decisions

is a short discussion of my decision to not seek treatment for my own depression: that is in the context of a ‘Twitter chat’ I’ve been having with a doctor.

The third piece

Complex Nuance is reduced to False Binary Choice – and True Binary Choice is falsely blurred

is something I cobbled together when I heard a phrase on Radio 4 recently: it isn’t necessarily as well-written as it could be, because I wrote it ‘on-the-fly’, but some readers might see ‘what I’m getting at’.

Associated files and links:

mike stone 21/09/17

I have decided to post links to some of my Tweets - more specifically, to some of my 'linked series' of tweets - in this thread, as well as posting PDFs.

My tweets often 'cheat' - I upload an image file, which is a screenshot of text, so I 'break' the 140-character limit. So my tweets are often similar to, but more 'bite-sized' than, my PDFs.

I have posted a series of linked tweets which examine, section-by-section, part 4 of the Mental Capacity Act at:


I want to know if professionals accept that family carers should 'follow decisions made and expressed by their dying loved-one even if those decisions 'are not embedded within 'the records'' - my own answer is 'yes, the patient decides!':


I posted a series of tweets - which I hope are 'thought-provoking' - about end-of-life at:


I have explained in two tweets - and a lawyer gave me an 'off-the-record agreement' ('I would not be able to comment officially on your tweets – but privately (for what it’s worth) they look spot on to me!') - that it is complying with section 4(9) of the Mental Capacity Act, which is the legal requirement around decision-making when the patient/person lacks mental capacity:


mike stone 21/09/17

If anyone finds any of the above 'useful' then - and you will need to 'browse for yourself' - all of my 'image tweets' (hundreds of them) can be found at:


One I would point at, is at:


I get very annoyed indeed, by the 'paradoxical systemic behaviour' which I point at in that tweet!

mike stone 30/11/17

I was looking at a Welsh website about Advance Care Planning (ACP) last week - I became so 'frustrated' by what I was finding on the website, that I decided to write a piece about ACP to send to the website.

The website is at http://advancecareplan.org.uk/

One of my major issues with the website, is that it doesn't appear to match-up with the reality of what happens if family-carers and 999 paramedics are interacting, 'during an emergency' and when the patient is at home, and isn't able to make and express decisions (i.e. when the patient 'has collapsed' or is in cardiopulmonary arrest). The 999 Services do not default to 'believing the family carer' - the 999 staff seem to be 'records-led' in their behaviour. And, for both ACP and also Advance Decisions, mentally-capable patients can change their minds at any time of their choosing - 'the clinical establishment', including ReSPECT http://www.bmj.com/content/356/bmj.j876/rr-7 seem unable to accept that when end-of-life patients are at home, the patients might have expressed a decision to a family-carer FIRST. Often, it is the people sharing a home with the patient, who are the only people a patient can give a decision to: 'the system' seems to want 'proof about' things - what happened when we were not there - which it unreasonable to want proof for.

It is abhorrent to default to 'we don't trust family carers BY DEFAULT' - it is quite bad enough, when your loved-one is dying, without then being confronted by 999 staff who imply that you cannot be trusted!

Associated files and links:

mike stone 07/12/17

I have just posted a series of 'video talks' – short slide-shows with a voice-over – on Twitter. I'm new to these - I only made my first one (not one of these, one I posted earlier in the week) last weekend: and I find making them something of a challenge, compared to writing a piece. However - videos on Twitter are only up to about 2 minutes, so these are short: also, apparently some people prefer to listen rather than to read (although listening to me, might be another matter - I'm no Richard Burton!).

These 4 are about section 4(6) of the Mental Capacity Act, and Best-Interests Decision-Making.





Also a video talk about the complexity of communication during end-of-life at home:


And a video talk about what the MCA provides (a legal defence, not a legal authority) and also about Best Interests compared to Necessity:


Feedback – are these short video talks helpful or not, and have I said anything wrong in them – would be very welcome.