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Ethical Scenario 6


Mr Jones, a 50 year old gentleman with advanced liver cancer, requires an urgent liver transplant. A suitably matched liver has been identified; however Mr Jones is refusing the transplant. Mrs Jones (Mr Jones’ wife) insists that you perform the transplant, stating that she is happy to consent on behalf of Mr Jones.
 
Explain what actions you would take in this scenario
​


Average Candidate Response
  • I would complete the transplant allowing Mrs Jones to consent on behalf of Mr Jones.
  • Mr Jones will likely pass away without the transplant, and hence it is essential to perform the transplant in his best interests.
  • Mrs Jones cannot consent on behalf of Mr Jones, and hence I would not complete the liver transplant.
    ​
​Excellent Candidate Response
Central to any medical decision by an adult is their capacity. Initially, it is essential to assess if Mr Jones has capacity to consent to a liver transplant. In order to be deemed capacitous, Mr Jones has to be able to understand, retain, weigh up and relay the essential information and risks pertaining to having/refusing a liver transplant.

If Mr Jones is deemed to have capacity, it is not possible to override his decision, nor can another individual consent on his behalf. In the event that Mr Jones does not have capacity, it is important to consider any advanced directives (AD) or Lasting Power of Attorneys (LPAs) that Mr Jones may have appointed whilst he had capacity.
 
If there are no AD or LPAs, an advocate can be appointed on Mr Jones behalf (to represent his likely views), and an MDT discussion arranged to assess what action would be in Mr Jones’ best interests. Whilst the wishes of Mrs Jones should be taken into consideration, Mrs Jones cannot consent on behalf of Mr Jones, nor should her views be assumed to be definitively in Mr Jones’ best interests.
​
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