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Advance statement overrides

 

Analysis of notifications of treatment that is in conflict with an advance statement 2009-10

AR-09-10-Table23

Our interest in this

Advance statements are one of the ways of that patients can participate in their care and treatment. Whilst we do not know how many advance statements have been made, we must be informed when one is overridden.

Participation is a key principle of mental health law and it therefore important to understand the circumstances in which an advance statement has been overridden. When we are notified of a potential override we make enquiries to find out whether it is a genuine override and, if so, what steps have been taken to discuss this with the person concerned.

What we found

We were notified of 137 potential advance statement overrides. Some of these came to us from the Tribunal, some from responsible medical officers MOs and some from 'second opinion' doctors, who had been asked to authorise treatments where people did not or were unable to consent. Out of this, we found 29 genuine overrides. The others were notifications in error, either because there was no advance statement, or because the particular treatment had not been specified in the advance statement. On a few occasions the person had subsequently agreed to their treatment and had decided to rewrite their advance statement.

Of the genuine overrides, the majority (16) were in respect of depot medication, where the advance statement indicated a wish for oral medication only.

We found some "advance statements" which had been made by the person at the time of their Tribunal hearing. We regard these as contemporaneous statements about care and treatment which anyone should be able to make at such a time and which should form part of the routine discussion about individual care and treatment. As an 'advance statement' it would only have effect if the person then lost capacity.