British journal of nursing (Mark Allen Publishing)
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The Court of Appeal has once again caused a flurry of consternation with its decision that patients incapable of giving consent to admission to psychiatric hospital must, if the statutory provisions are present, be admitted compulsorily under the Mental Health Act 1983. This article submits that this decision can only cause increased bureaucracy and distress for thousands of mentally incompetent adults. The long-term solution is for the Law Commission's proposals for decision making for mentally incompetent adults to be enacted.
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Since its introduction in the 1960s, cardiopulmonary resuscitation (CPR) has been universally available to all hospital patients unless the consultant in charge has specified a 'do not resuscitate' (DNR) order. The public perception of CPR has tended to be one of overoptimism, but this is not matched by the low survival to discharge ratio of approximately 1:10. In addition, there is the risk of prolonging suffering, compared with the quick and relatively painfree alternative offered by cardiac arrest. Decisions about resuscitation pose many ethical dilemmas for those involved and should take into consideration the patient's wishes, prognosis and quality of life.
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The recent document 'Signposts for Success' (Department of Health (DoH), 1988a) offers an extensive blueprint for the strategic development of services for people with a learning disability in the next decade. This article discusses the key issues raised and some of the controversial aspects that have to be addressed.