Media Watch 543

Attached is the current issue of Media Watch (#543).

Of particular interest:

Awake and (only just) aware? A typology, taxonomy, and holistic framework for withdrawing clinically assisted nutrition and hydration in the minimally conscious state

MEDICAL LAW REVIEW | Online – 13 December 2017 – Decisions to withdraw clinically assisted nutrition and hydration (CANH) from people in the minimally conscious state are predicated on the question as to whether it is in the individual’s best interests to continue with CANH and determined traditionally using a “balance sheet” approach. The emerging case law in this area suggests that decisions may appear inconsistent and lack sufficient certainty and clarity of process. Using an analysis of statute, common law and academic commentary, the authors articulate a typology for the elements that tend to engage in these decisions. Next, they construct a taxonomy of overarching legal and ethical issues and then proceed to develop a novel framework for holistic decision-making. The authors validate this on the principle upon which it is grounded: coherent weighting of elements and theoretical proof of concept. The framework has potentially far-reaching benefits that include consistency and transparency of decision-making, thereby enabling a more uniform judicial approach. The authors suggest this as a foundational paradigm for decision-making in this context. 


“Worried to death”: The assessment and management of anxiety in patients with advanced life-limiting disease, a national survey of palliative medicine physicians

BMC PALLIATIVE CARE | Online – 11 December 2017 – To the authors’ knowledge this is the first national survey [of members of the Association of Palliative Medicine (of Great Britain & Ireland)] exploring how palliative medicine (PM) physicians assess and manage anxiety in their patients. It highlights the infrequent use of screening tools, substantial variation in prescribing practice, potentially inappropriate use of benzodiazepines in patients with a prognosis of months, training gaps and poor access to psychological and psychiatric services in the U.K. This suggests that PM physicians should receive formal training in the management of anxiety and develop local referral networks with mental health services. The findings also highlight the urgent need for further research into the pharmacological management of anxiety in the palliative care population. The development of a U.K.-wide guideline is an essential next step in supporting clinical decision-making, service development and ultimately improving patient care. 

N.B. Please note that Media Watch will not be published the w/o 25 December 2017.