Mental Capacity Act. A Race With Time.

It is always worth reading the Acts people talk about. I find it an extremely useful way to try and understand the status quo. It is also worth reading the Code of Practice. The DCA has further documentation on this issue.

From my side of things, I genuinely feel it is a good idea to develop patient autonomy. From personal experience, the capacity issue came to a serious head to head challenge between myself and Mr Samer Nashef. My father had cognitive deficit following a old head injury. He also had an acute confusional state due to an untreated infection in 2005.

Samer Nashef had made is mind up that he would insert his views in place of my father's. There was no Mental Capacity Act in those days and each member of staff neglected my father's prior tape recordings stating his wish to live and the fact he understood the repercussions of a aortic valve replacement operation. On one side, my father was terribly ill and on the other side, I watched Nashef insert his decision without so much as a capacity assessment. In his view, no assessment was required. I had never seen this done. I know that we had all been taught how to assess capacity and the Department of Health had a protocol for it. He then requested that I remove my father from the hospital bed, place him in my car and drive him 50 miles back home to die - while his oxygen saturations were dropping. So lets see, Nashef and his group of half witted colleagues saw the scans, agreed to have my father transferred to Papworth. As soon as he landed there, they wanted him to get back in the car [ not the ambulance he had been red lighted in] and return home. Two of us were there speechless. I looked at him and thought he was indeed the most evil man I had ever met in my entire life. This conceited surgeon had previously crowed in the Guardian about how proactive he was towards the elderly. I never understood why he was such an idiot on the day of the assessment but there we are. In his view, those with a chest infection didn't need time for recovery, they just needed to die. I was right there fighting for my father - at the nursing station, I quoted every Protocol, every case law and every bit of knowledge I knew. I knew about capacity. I was a psychiatrist so I had done it every day of my life. Now, it was my turn to get my father his rights. We finally [with some excessive hard work] got the reassessment and the operation. Sadly, by then it was too late - the day before his operation, he was found dead in his hospital bed. Time had beaten us. In essence, we were four doctors. We failed to win the race. We sat there after four days wondering what would happen to a lay person. They had no chance in this cruel place. Some places are cruel and toxic.

Nashef was overinflated prat of a surgeon; full of his own arrogance. I can say that in full view of the public because that is who he is. A few days later, Nashef got his wish. He achieved what he always wanted. A dead patient. I am sure they all celebrated. I didn't cry when my father died. I never cry - I knew it was now too late. I wrote one polite letter to the surgeon explaining that they had robbed my father of his life and left the hospital.

Since the death of my father, Papworth NHS Trust has been plagued with a mass of bad publicity. Then as my father always said, what comes around goes around and he also stated that in time Nashef will also know the meaning of playing God. People meet their own fate paved by their own mistakes.

The fact though remained was that this dead patient was an elderly retired consultant. Nashef was a tall, young surgeon who liked to control life and death. In 30 more years he would be just like my father. I do hope that he too is assessed from a distance and sentenced to death by his own colleagues. Some people deserve bad karma and he certainly does. I was in his consulting room, I looked at his perfect life, his perfect children and his perfect wife. I then looked at him. Some people are simply born imperfect as human beings. He was imperfect in many ways. He wasn't human anymore. He was a cosmetic production of Papworth.

Nashef has never been able to justify his decision making, not by research or directive. That is because he never followed the NHS directive to assess capacity. He won't be struck off of course because lets face it, he is a Papworth NHS Trust surgeon and my father was a asian consultant. It gave them pleasure to kill because that is what happened. It also gave him immense pleasure to lie through the complaints made by my family. He insisted he had examined my father. He was filmed on his entire assessment and he didn't even know it. Mobiles are pleasant things when catching liars. That though is for a rainy day.

The above patient was my father so his death will not matter to many people. Most doctors assume that they too will always be fit young people able to control the way people live or die. None of us are getting younger. All of us are getting older.

There is one principle of capacity to understand. If a patient has capacity to understand and make a decision - they have the right to live and the right to die. Bad Medicine features a number of issues regarding the debate on capacity. The subject can be intellectualised far too much.

The bottomline in this - Death by Indifference exists. We have a medical profession who are known to be discriminatory in many ways. Giving doctors like this complete control is dangerous. Few doctors appear open minded about age, disability, cognitive impairment. The NHS is institutionally discriminatory. In that environment, the patient and their relatives have to have some way of asserting their rights. Had I had the Medical Capacity Act in 2005, my father would probably be alive today because the delays caused in the medical staff's failure to assess capacity probably cost him his life. As I say, as a life, my father's will not matter to the majority of people but it mattered to me - much like each patient matters to their relative.

Dr Grumble preferred the law when it was vague. The Act is not perfect and there will be teething problems. Perhaps the medical profession should have been less supine and involved themselves in the creation of the Act rather than allow lawyers to draft it.

As for the lady who killed herself. The probability is that the NHS would never have been able to save her anyway. Every day, people make a choice to hang themselves, poison themselves, drug themselves and die. It is a conscious choice to end their intolerable lives. The reason they are not in the media is because the medical profession are not called to them. They made a choice to die. Who are we to say that they shouldn't have the right to end their lives just like they have the choice to live?

I can understand the fact that doctors are probably a bit incensed by the Act, it probably means they have to use their brain for once as opposed to inserting what they think is the choice the patient should make. We as doctors are information givers. Patients are decision makers. It is often tempting to play God but it is best left to God himself if he exists.

Samer Nashef will not be having a good day from now on. He might have to actually read the NHS Protocols on capacity. There is only about 30 years between him and a hospital bed.