P-281: 'He Is A True Christian Scientist, Doctor'

摘要

An 86 year old frail Christian Scientist (CS) gentleman, with no medical history or regular medication, was admitted to hospital via ambulance by his CS friends following a fall and long lie. He had multiple pressure sores, was septic and delirious. He lacked mental capacity on treatment decisions, and was given intravenous antibiotics and fluids. He had no Advanced Directive. Two days later he had improved, removed his cannula and was refusing all treatment. His only advocates were friends, who were CS. They stated he had been a CS for 20 years; in their doctrine, no CS should go to hospital or take medicine as this denies 'divine science'. They acknowledged this behaviour was in keeping with his strongly held beliefs. He was deemed to have capacity for this decision and then agreed a compromise of oral fluids and antibiotics. Key learning points: Under the English Mental Capacity Act, people lacking mental capacity, can be treated without consent if in the person's 'best interests'. This includes assessments of a patient's belief, preferences, and values, and the views of others concerned for the patient. Treatment to preserve life and health in an emergency is assumed to be so, unless specifically refused. At face value, treatment should be discontinued if it is not congruent with strongly held religious belief. However, in the absence of documentation, 'hearsay' evidence may be too uncertain to act on. We cannot assume every Christian Scientists' beliefs are the same. Seek a second opinion in managing complicated patients.