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Mental Health Bill [HL]

I hesitate to draw attention to any of the wording of the amendment in the light of the two previous speakers and because the sentiment behind the amendment is so terribly important. I have a small concern as a clinician who does not work in mental health that the understanding out there is that an advance decision to refuse treatment made by someone with capacity will be legally binding and that advance statements such as the one we were shown by the noble Baroness, Lady Knight of Collingtree, are advance statements of wishes and preferences should the situation arise. However, when patients are placed under compulsion we need clarification of which Act will become the overriding Act. The other aspect on which I have a small concern is that the amendment says that an advance decision need not be in writing. I have a difficulty with something being legally binding if it has not been clearly recorded somewhere. If a patient wishes to tell me what they do not want done but they are not going to write it down, I will, in good clinical practice, record it in the notes. I will read it back to them and have someone there as a witness to the fact that I really am reading back what I have written. They may countersign it or have the person sign it on their behalf, but it acts as a verification procedure so that something is clearly written down and so that the wording has been checked out with the patient. If a situation arises and another clinician who has not had those conversations is dealing with the patient, those conversations are clearly recorded. The other provision is correct in that a withdrawal or partial withdrawal need not be in writing. However, I have another concern in that if an advance decision is going to be altered in advance, something should be clearly recorded in writing and agreed so that there is a record of the patient’s wishes which cannot be disputed. The other matter is the typographical error right at the end of the amendment, which is completely trivial. I feel that the aspect of recording a decision in writing needs to be looked at.