Abstract

One of the main reasons for contact of psychiatric patients with Accident and Emergency (A&E) departments is deliberate self-harm. The situation is often complicated by the patient's ambivalence about treatment. Kerrie Wooltorton was one such patient who presented to an A&E department after having self-harmed by taking a fatal dose of antifreeze. She had an Advance Decision forbidding any treatment for her overdose, and continued to refuse the treatment. Her wishes were honoured and she died 3 days later. The case raises many ethical and practice issues, and this review aims to clarify the medico legal position in such a situation. It draws on the Mental Capacity Act and case law, which clearly favour preservation of life, to argue that there are many lessons to learn from this case. There are enough safeguards for treating clinicians if they are not satisfied of the validity and applicability of the Advance Decision and decide to override it. Alternatively, any decision to follow the Advance Decision has to be objectively supported by evidence. The Mental Capacity Act itself allows for overriding the patient's wishes if certain criteria under the Mental Health Act are met. This route was not explored in the Wooltorton case and this is the main lesson to learn.