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egain capacity, and the absence of coercion. By considering standards in other settings, it would appear essential to provide a written booklet on the above aspects and for the interview to be carried out jointly by senior practitioners from intensive care and genitourinary medicine. [This strategy has been defined and carried out within the critical care environment of the General Infirmary at Leeds over the last 18 months]. Legal, political and professional implications of these proposals The above strategy would arguably not require any change in legislation since the Human Tissue Act does not specifically prohibit serological testing but simply dictates that any intervention be in the patient’s ‘best interests’. For the protection of the involved health care practitioners, it would however clearly be helpful for government to endorse an expanded interpretation of ‘best interests’ to include ‘values and beliefs’ as well as purely medical best interests, and the role of the next of kin in determining those best interests for the individual patient. If such endorsement were not to be forthcoming, it should be apparent that non heart beating organ donation could no longer be considered viable, since the process is critically dependent on a parallel expanded interpretation of best interests and the assent of the next of kin. With such endorsement however, it would then fall to the health-care professions to explicitly define process as above to ensure provision of all essential information and avoid any consideration of coercion. 1 2 3 4 5 6 Re F (Mental Patient: Sterilisation) [1990] 2 AC 1 (HL) Department of Health. Good Practice in Consent. HSC 2001/023 GMC. Seeking patients' consent: the ethical considerations. GMC November 1998 Ridley S, Bonner S, Bray K, et al. UK guidance for non-heart beating donation. Br J Anaesth 2005; 95:592-595 Bell MDD. Non-heartbeating organ donation – clinical process and fundamental issues Br J Anaesth 2005; 94: 474-78 Isaacs Report. Department of Health. London May 2003 Appendix6 3
Needle-stick Injuries from a Patients Perspective The options considered at the meeting of /May 9 th with regard to the testing of patients who have been the source of needle stick injuries were discussed with a broad range of people i.e.: Yorkshire Cancer Network, Members of the Membership Council of the local Trust, Members of Cancer Connections, general members of the public with the ages ranging from late teens to 70s. There was a general concern that NHS staff (considered in the widest terms) could be left in a vulnerable situation, emotionally and psychologically should there be a needle stick injury, with no recourse to testing if there is no permission given by the source of the possible infection. They did not believe that it should be an occupational hazard that should be accepted. The general opinion was that all staff had the right to work in a safe environment and that their rights were every bit as important as the patients. There was an overwhelming belief that there should be effective training in place for all staff on how to deal with equipment that could cause a needle-stick injury and how to dispose of it correctly; also that the correct equipment for disposal should be a top priority for all Trusts regardless of costs. There was also a belief that the training should be updated regularly so that standards of care were maintained. It was also felt that all Trust should be aware of the safest equipment on the market and encourage staff to use it, thereby having an environment of good practice. There was a wish expresses that an environment of openness operates within the NHS so that staff felt that they would be well supported if a needle-stick injury occurred. All six options were presented to the individuals questioned. There was a range of responses as to how the case for needle stick testing should take place, A) Probably most felt that there should that there should be blanket testing, that a form should be signed when admitted to hospital for any procedure. Even when it was pointed out that certain patients might not present them-selves for
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egain capacity, and the absence of coercion. By considering standards in other<br />
settings, it would appear essential to provide a written booklet on the above aspects<br />
and for the interview to be carried out jointly by senior practitioners from intensive<br />
care and genitourinary medicine. [This strategy has been defined and carried out<br />
within the critical care environment of the General Infirmary at Leeds over the last 18<br />
months].<br />
Legal, political and professional implications of these proposals<br />
The above strategy would arguably not require any change in legislation since the<br />
Human Tissue Act does not specifically prohibit serological testing but simply<br />
dictates that any intervention be in the patient’s ‘best interests’. For the protection of<br />
the involved health care practitioners, it would however clearly be helpful for<br />
government to endorse an expanded interpretation of ‘best interests’ to include<br />
‘values and beliefs’ as well as purely medical best interests, and the role of the next of<br />
kin in determining those best interests for the individual patient. If such endorsement<br />
were not to be forthcoming, it should be apparent that non heart beating organ<br />
donation could no longer be considered viable, since the process is critically<br />
dependent on a parallel expanded interpretation of best interests and the assent of the<br />
next of kin. With such endorsement however, it would then fall to the health-care<br />
professions to explicitly define process as above to ensure provision of all essential<br />
information and avoid any consideration of coercion.<br />
1<br />
2<br />
3<br />
4<br />
5<br />
6<br />
Re F (Mental Patient: Sterilisation) [1990] 2 AC 1 (HL)<br />
Department of Health. Good Practice in Consent. HSC 2001/023<br />
GMC. Seeking patients' consent: the ethical considerations. GMC November 1998<br />
Ridley S, Bonner S, Bray K, et al. UK guidance for non-heart beating donation. Br J Anaesth<br />
2005; 95:592-595<br />
Bell MDD. Non-heartbeating organ donation – clinical process and fundamental issues Br J<br />
Anaesth 2005; 94: 474-78<br />
Isaacs Report. Department of Health. London May 2003<br />
Appendix6 3
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