Abstract
The 1984 Scottish Mental Health Act (and its counterpart in England and Wales) invoked unique restrictions in medical practice in this country. For the first time certain standard treatments could not be given to particular patients unless an independent second opinion doctor authorised that treatment. Fortunately, in respect of drug treatment and ECT the second opinion doctors are themselves practising clinicians. Second opinion doctors are asked to give their opinion about the suitability of a proposed treatment using the following guidelines: “the appointed doctor will have in mind his/her understanding of practice accepted as proper by a responsible body of medical men skilled in this particular art in Scotland at this time and should avoid any idiosyncratic view of treatment however firmly held”.
Highlights
The 1984 Scottish Mental Health Act invoked unique restrictions in medical practice in this country
For the first time certain standard treatments could not be given to particular patients unless an independent second opinion doctor authorised that treatment
Second opinion doctors are asked to give their opinion about the suitability of a proposed treatment using the following guidelines: "the appointed doctor will have in mind his/her under standing of practice accepted as proper by a respon sible body of medical men skilled in this particular art sinynSccroattilcanvdieawt othf itsretaimtmeenatndhoswhoeuvledr faivrmoildy ahneyld"i.dio faiTrlhyatsuismmraathriesreda masoumthefuanl inagnd 'nIortmhianlk caocuceldptebde practice'
Summary
A solution to medical uncertaintyand publicdoubt? ERNESTP. WORRALLC, onsultant Psychiatrist, Southern General Hospital, Glasgow. There is debate about the treatment of first choice for such a patient and there is sufficient litera ture available to make estimates of the probability of the various outcomes with different treatments This decision tree is used by me in my own clinical practice, used as an example in training junior staff and the social worker who is attached to my team and who is a Mental Health Officer involved in consent to admission and understands the model and takes a valued part in decisions about treatment decisions using the model. If that treatment is ECT the Royal College of Psychiatrists has advised that when an informal patient is unable to give valid consent to ECT the patient should be detained and second opinion authorisation for ECT obtained
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