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By Holden A.V.

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In primary and secondary care, the importance of hearing and understanding patients’ views is a vital part of the relationship. Clear communication is also a key element of valid patient consent (this is discussed in Chapter 3). Health professionals should try to understand patients’ views without making assumptions about the importance they attach to different outcomes. Chronic diseases impact on patients’ lives in various ways. People need information to manage their condition in ways compatible with their own wishes and lifestyle.

Many of these are a mixture of advice on the law, ethics and what is currently seen as clinically appropriate and may be published by professional bodies, such as the BMA and the Royal Colleges. Where relevant in the following chapters, this type of guidance is flagged up. Ethical decision making The law provides a framework for practice and, in some cases, gives clear direction as to what action is needed. In other cases, two or more options would be legally permissible and some analysis is required to decide what would be 12 EVERYDAY MEDICAL ETHICS AND LAW Recognise that a dilemma exists Dissect the problem Do you need more information?

Withholding treatment is seen as appropriate if patients’ treatment is nonessential or their behaviour poses risks of harm to other patients or staff. Primary care practices can request the removal from their lists of any patient who is threatening or violent (see also the section ‘Breakdown of the doctor– patient relationship’). In some premises, special segregated areas or after-hours clinics deal with persistently aggressive patients in a secure environment with police or security officers on hand.

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