There are various people who could be consulted about whether to proceed with NG feeding for Freda. Click on the plus symbol next to each person to view their role and opinions.
The interactive model above has highlighted the importance of using a shared decision making approach. This means that the decision about whether to proceed with NG feeding for Freda is not made solely by a health professional, but rather that it is a collaboration between health professionals, Freda (the patient) and her family which allows the following to be discussed:
Possible treatment options, evidence, risks and benefits
The patient’s preferences, personal circumstances, goals, values and beliefs.
For further information about shared decision making see the additional information box below.
The daughter
Freda’s daughter is not keen for any invasive interventions and wants her mother to be kept comfortable.
The welfare guardian
No one has been appointed legally to make decisions on Freda’s behalf.
Guardianship under the Adults with Incapacity Act is intended for ‘continuous management’, to help an adult who needs long-term involvement from someone else to make decisions involving his or her financial or welfare matters, or both.
You can apply to the local sheriff for a guardianship order. Guardianship can cover property and financial matters or personal welfare, or a combination of these. It is likely to be suitable where the adult has long-term needs in relation to these matters and has lost, or has never had, capacity to take decisions or action on these matters for him or herself. The sheriff would have to be satisfied that the adult is incapable with regard to the matters in question, and that there is no other suitable means of safeguarding or promoting the adult’s interests in these matters. For example, it might be appropriate to apply for guardianship where a person with serious learning disabilities reaches adulthood. It might also be suitable where someone has moderately or severely advanced dementia. For further information visit Scottish Government: How guardianship is set up and Adults with incapacity forms and guidance.
The son
He is planning to fly over from America and is very worried about his mother’s condition. He would like her to receive nutrition by whatever means is possible.
The solicitor
Freda does not have an advanced directive. This would have been written whilst she had the capacity to determine her decisions for treatment in the event of an illness that later meant that she would be unable to give consent.
Advance health care directives, also known as advance directives (Scotland) or advance decisions (England and Wales), are instructions given by individuals specifying what actions should be taken for their health in the event that they are no longer able to make decisions due to illness or incapacity. It allows them to state in advance their refusal to consent to specified health care in defined circumstances e.g. not to be fed by artificial means in the event of a stroke/brain injury.
The multidisciplinary team
This includes the consultant, nurse, dietitian, and speech and language therapist. They agree that Freda has some potential for recovery (it is only 2 days post-stroke) and a period of feeding to see if any improvements occur in her medical status over a determined timeframe would be appropriate at this stage.
Freda’s previous anecdotal comments
Freda had told her daughter a few months ago when watching a TV programme about end-of-life issues, that she wouldn’t want to be fed with a tube if she had a serious illness. This was only conversational and there is no written evidence to determine her care. Her views may have changed since then.
Additional Information
Shared decision making:
The NICE definition of shared decision making is when health professionals and patients work together. This puts people at the centre of decisions about their own treatment and care. When making decisions together, it’s important that:
care or treatment options are fully explored, along with their risks and benefits
different choices available to the patient are discussed
a decision is reached together with a health and social care professional
‘Supported decision-making’ has no formal definition, and different people use it differently. We use it to refer to any process in which an individual is provided with as much support as they need in order for them to be able to:
Make a decision for themselves; and/or
Express their will and preferences within the context of substitute decision-making (for example, guardianship).
Supported decision-making maximises an individual’s ability to ensure that their rights, will and preferences are at the centre of all decisions that concern them. It is important that everyone involved with individuals with decision-making difficulties is aware of the importance of support for decision-making and thinks about how best it can be provided.
