Despite the introduction of the Mental Capacity Act in 2005, healthcare professionals remain uncomfortable with individuals who choose not to follow medical advice - who make informed decisions to decline a treatment or management plans. This paper highlights that speech and language therapists are one of those professions who often feel uncomfortable when people refuse to follow dysphagia recommendations. The authors cite a study, reporting that up to 40% of nursing home residents are not following dysphagia recommendations. These individuals are often labelled as ‘noncompliant’ or ‘nonadherent’. Yet it is often a lack of understanding of the rationale for the treatment recommendation that drives this decision. The article goes on to outline the role of health professionals in America, specifically speech and language therapists in relation to consent and decision-making. They highlight the role of all health professionals to acknowledge and uphold our patient’s autonomous decisions regarding their medical care. Decision-making is time and situation-specific, and information needs to be provided in order to make such a decision. The authors outline that in America this information must be specific to the person and outline: 1. Material facts considered relevant to a decision; 2. Truthful responses to a patient’s questions regarding the healthcare professionals experiences with a procedure; 3. The individuals involved during a procedure and 4; Additional procedures that would be required in the event of a complication. To do this effectively, the healthcare professional should themselves be aware of the current evidence in this area and put the person at the centre of the decision. This is extremely relevant to health professionals across the UK, who operate within a health service often at odds with the principles of autonomy and self-determination that underpin the Mental Capacity Act.

Complexity of Clinical Decision Making: Consent, Capacity, and Ethics.
Askren A, Leslie P.
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Anna Volkmer

UCL, London, UK.

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