By Singh S., Ernst E.
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Optimize the senses (glasses/hearing aids), ensure a comfortable familiar environment with good lighting and heating, bring an advocate to the meeting, provide writing materials, and an interpreter, etc. CONSENT AND COMPETENCE • Patients are entitled to make seemingly illogical decisions provided they are made with competence • Patients may be competent even if they are mentally ill • Patients may have lucid intervals Speciﬁc situations In palliative medicine we may be asked to assess competence in order that a patient can, for instance, make a will, change a codicil to a will, execute a Lasting Power of Attorney or document Advance Decisions to refuse treatment.
The mnemonic ABCD stands for Attitude, Behaviour, Compassion and Dialogue. Attitude Professionals need to be respectful in their attitudes towards patients, acknowledging the patient as an individual with cognisance of many issues including culture and ethics. Professionals unwittingly make incorrect assumptions: seeing a patient who has difﬁculty in communicating does not mean that he/she is not competent to have an opinion about his/her care. The attitude of the professionals to a patient plays a large part in determining the patient’s ongoing sense of worth, a factor which is often underestimated.
It is still relatively common for a precise prognosis, for example ‘six months’, to be given and this is invariably inaccurate. If the patient dies before the due date, the family feel cheated of time that they would otherwise have spent differently had they known that time was so short. If the patient survives longer than the due date, both patient and family may feel proud that they have defeated the odds and take comfort from this; on the other hand, if the family have altered their lifestyles including giving up work (and salary) to look after a patient who has not signiﬁcantly deteriorated by the due date, family tensions inevitably build up alongside all the normal feelings of guilt and anger.