What does 'a Consensus Decision' mean ?
I was listening to BBC Radio 5 this morning, and there was a piece about Dr Chris Danbury calling for 'mediation' to be made compulsory when families and clinicians disagree about what is best for the patient.
Dr Danbury said on R5 'mediation offers an opportunity to come to a consensus decision'.
I have a question [which I've just e-mailed to Dr Danbury] about that sentence, which I would be very interested to get feedback on:
Does 'consensus decision' mean, to you, a decision everyone agrees about, or does it mean 'most people agree, but a few disagree ?'.
In my EoL/MCA stuff, I do write that I dislike the 'going to court' situation, and I also write that 'if everyone agrees, you've arrived at 'the best decision' and you have done that without needing to claim there was a decision-maker', but I am deeply unhappy with any suggestion that we should be arguing that 'the position of the majority is correct'. There are legal grounds for my position, which I explained in a comment to something Dr Danbury wrote for the BMJ about his 'mediation would help' campaign:
http://www.bmj.com/content/352/bmj.i222/rr-0
I wrote in my piece:
'If we adopt my position, that unless somebody is empowered by section 6(6) everyone should be contributing whatever they can to the formation of the best possible best-interests decision (clinicians contribute clinical prognoses, family and friends individually answer the crucial question of 'what would the patient have decided ?'), and with luck a unanimous decision emerges, then that unanimous decision is the one to be adopted by everyone. But, if there isn't unanimity, where does 'mediation' fit in ?
An honest consideration of section 4 of the Act, first requires a person to answer the question 'Am I sufficiently well-informed to properly consider section 4, and thereby to defensibly claim compliance with section 4(9) ?'. If the answer is no, you would not be involved in 'mediation' [about 'what is the best best-interests decision']. If the answer is 'yes', then your own best-interests decision is the one you must follow: that is obvious, from the wording of 4(9).'
I've just gone online, and looked the story up - the first report I read was at:
http://www.bbc.co.uk/news/health-36407596
and it includes this, which I STRONGLY object to:
'Another instance where mediation could be used was when a patient who is mentally competent did not want to accept a treatment they medically needed'
If Chris thinks that, then not only are we on different sides of the argument, but he is also at odds with English law and the Mental Capacity Act - mentally-capable patients make their own decisions, and clinicians provide the patient with information: it really is that simple, unless you completely tear up the MCA !
Anyway, I'll end with the question I asked earlier, in the hope of getting some opinions:
'Does 'consensus decision' mean, to you, a decision everyone agrees about, or does it mean 'most people agree, but a few disagree ?'.'
I've been swapping e-mails with Chris Danbury for a few days.
Weirdly, when I said 'your position would require a change in the law' Chris implied it wouldn't, and pointed me at a court case: it turns out it was the court case I usually use to prove that mentally-capable patients are autonomous, so 'mediation during capacity' isn't consistent with our law. I'd written about the case on BMJ:
http://www.bmj.com/content/351/bmj.h6575/rr-0
Anyway, Chris sent me this yesterday - I 100% agree with, all of this, if my dislike of this word 'consensus' is kept in mind:
'Yes - I agree. When the patient has capacity, then the patient decides.
When the patient lacks capacity, then decision making can be difficult. Where consensus exists, then there are not likely to problems at a later date. Where consensus does not exist, then that's what potentially leads to litigation.
Mediation offers the potential for a consensus to be achieved.
In my opinion, that consensus is depends on the individual context and can't be generalised.'