Report on Bioethics: Advance Care Directives - Law Reform ...

making her decision to refuse a blood transfusion, Ms K had not properlyweighed that information in the balance, balancing the risk of death inherent inthat decision and its consequences, including its consequences for her newbornbaby, against the availability of a blood transfusion that would preserve herlife.1.54 The fourth principle set out by Laffoy J was that, with regard to thetreatment information by reference to which the patient‘s capacity is to beassessed, a clinician is under a duty to impart information as to what is theappropriate treatment, that is:―what treatment is medically indicated, at the time of the decision andthe risks and consequences likely to flow from the choices availableto the patient in making the decision.‖Laffoy J held that Ms K‘s clinicians had given her the information necessary toenable her to make an informed decision as to whether to accept or refuse ablood transfusion. That information was conveyed in layman‘s terms from whicha competent adult whose capacity was not impaired should have understoodthe gravity of the situation. The fifth principle set out by Laffoy J was that adistinction was to be drawn between a misunderstanding of the treatmentinformation in the decision-making process, which may be evidence of lack ofcapacity, and an irrational decision, which is irrelevant to the assessment.1.55 The sixth principle discussed by Laffoy J was that the assessment ofcapacity must have regard to ―the gravity of the decision, in terms of theconsequences which are likely to ensue from the acceptance or rejection of theproffered treatment.‖ Laffoy J rejected the suggestion of Ms K‘s counsel that thepatient‘s capacity should be measured against the nature of the decision, ratherthan its consequences, citing the decision of the Supreme Court in Re a Wardof Court (No 2) 72 in support. When refusing a blood transfusion, Ms K hadsuggested to the Master of the Hospital that Coca-Cola and tomatoes might bean alternative solution to a blood transfusion. Laffoy J held that this suggestioncould ―only ring alarm bells‖ as to Ms K‘s appreciation of the gravity of thesituation when viewed objectively.1.56 Laffoy J concluded that Ms K‘s capacity was impaired to the extentthat she did not have the ability to make a valid refusal to accept a bloodtransfusion. Therefore, the administration of the transfusion was not an unlawfulact, and did not constitute a breach of her rights either under the Constitution orthe Convention.72[1996] 2 IR 79.26