Competent Patient – treatment options including the anticipated benefit and burden of continuing ICD therapy are discussed with him/her. Patient consents to withdrawal of ICD therapy Patient wished ICD therapy to continue Decision to withdraw ICD therapy is documented in their medical notes. Check discussion of deactivations performed with patient and consent gained from patient for deactivation. Decision communicated throughout the patient’s care team. Suitable handover arrangements put in place for care plans including advice not to resuscitate patient. Personal support given to both patient and those close to him/her. Education / Peer Review is supplied to patients about End of Life process. Reviewed at timely intervals. Contact ICD Department at the LHCH either between 9am-5pm or the out of hours Cardiology SpR via main hospital switchboard to arrange deactivation of ICD. Decision reviewed at appropriate intervals. Care plan reassessed to ensure treatment goals remain appropriate for the patient. Patient consulted throughout and second opinion
ALGORITHM 2: DECISION TO WITHDRAW ICD THERAPY IN AN ADULT PATIENT WHO LACKS CAPACITY TO MAKE DECISION Patient lacks capacity to make decision No advance decision, no lasting power of attorney and no person whom it is practicable or appropriate to consult No advance decision, no Lasting Power of Attorney, doctor in charge consults those close to the patient re Registered Attorney appointed under Lasting Power of Attorney (LPA) to consent to withdrawal of ICD therapy Patient has made an advance decision on withdrawal of ICD therapy, which is valid and applicable to current If failure to reach consensus on patient’s “best interests” seek second opinion. that in “best interests” to withdraw ICD therapy PCT/Trust has a duty to provide the patient with access to an Independent Mental Capacity Advocate (IMCA) Attorney wishes ICD therapy to continue consents to withdrawal of ICD therapy A
Record of Decision to Withdraw Implantable Cardioverter Defibrillator (ICD) Therapy in an Adult Patient Patient’s Name: Section 9 continued Is it the consensus view that it is in the patient’s “best interests” for ICD therapy to be withdrawn? Yes No If yes, proceed to section 10 If no and consensus cannot be reached about “best interests” and particularly if the patient/those close to them or the IMCA disagree with the clinical view, seek legal advice about how to proceed. Section 10 I am the doctor currently in charge of the care of Delete as necessary I am satisfied that I have obtained the patient's valid informed consent to withdraw ICD therapy. I have obtained the consent of the patient’s attorney, (who I am satisfied is appointed under an LPA to give consent in these circumstances) to withdrawal of the ICD therapy. I am satisfied that an advance refusal of ICD therapy exists, which is valid and applicable to the current circumstances. I am satisfied that the patient lacks capacity to consent to withdrawal of treatment and confirm that I believe it is in the patient’s best interests that ICD therapy should be withdrawn. I have attempted to complete the necessary steps to ascertain any relevant views/wishes of the patient prior to becoming incapacitated and have taken account of the views offered by those close to the patient (where available), the IMCA, where applicable, and the views of the multidisciplinary team. I am satisfied that the patient lacks capacity to consent to withdrawal of treatment and confirm that I believe it is in the patient’s best interests that ICD therapy should be withdrawn. Name Position Signature Date 18