Annex Summarising survey of the ‘checklist of considerations’

© EMGO-Institute 1997
Copy the results of the preceding pages, as far as applicable.
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A.1.6Is an intentionally curative treatment indicated for this patient?
□ yes, indicated□ I don't know□ no, not indicated
A physician is not compelled to act if this is not medically effective. Moreover, a request to treat can not be honoured if the treatment at issue is not in agreement with the medical professional standards. According to - among others - CAL,7 8 starting a treatment is undesirable if it is considered to be not medically effective, irrespective the wishes and opinions of the patient and other persons involved.
There should be a dialogue, however, with the nursing staff and the patient's representative(s), explaning the undesirability of installing treatment which is not effective.
A.2.3How physically and/or psychically burdensome would the total curative treatment - antibiotics and (re)hydration - be for the patient?
□ very burdensome□ somewhat burdensome□ not or little burdensome
When choosing the best treatment, beside the medical effectivity, the burden of treatment plays a part.
B.1.4Is the patient sufficiently mentally competent, and if so, what treatment does the patient want?
□ insufficiently competent□ sufficiently competent, wants curative treatment□ sufficiently competent, wants palliative treatment
In this situation, merely the present wish of the patient applies and the rules for informed consent must be adhered to. Neither a living will, nor family nor representative(s) play a role in the decision process.
B.2.9What is the purport of the living will?
□ unclear/absent□ patient wants curative treatment□ patient wants palliative treatment
In the WGBO(Dutch law) a negative living will has been given a legal status. A physician is compelled to follow the will when the patient does not wish a curative treatment, unless there are sufficient grounds (as mentioned in B.2.5–B.2.8) not to do so.
As a rule, there should be a dialogue with the nursing staff and the patient's representative(s). The living will, however, is decisive.
B.3.9What is the purport of the reconstruction of the patient's will according to the representative(s)?
□ absent/doubt/opposing opinions□ intentionally curative treatment□ palliative treatment
According to the WGBO, appointed as well as unappointed representatives have the authority to take decisions on the patient's behalf. The physician, however, retains his or her responsibility to test these decisions for medical effectiveness, and whether the representatives are actually reconstructing the wish of the patient (which has been tested in part B.3).
B.4.7What is the purport of the reconstructed patient's wish according to the other involved professional carers?
□ doubt/opposing opinions□ intentionally curative treatment□ palliative treatment
The nursing staff and other (para)medics are not authorized to make decisions. The treating physician retains this responsibility.
C.5Which treatment seems to be in the patient's best interest?
□ doubt/opposing opinions□ intentionally curative treatment□ palliative treatment
Finally, the physician bases his or her choice of the treatment on what is in the patient's best interest.