I completely agree with this post. I teach medical law (amongst other things) for a living and as I was reading through the whole debate I was surprised at how polarised people were in their viewpoints and thought how useful this scenario would be for use in a tutorial on consent and capacity. Whilst there is room for arguing that Tom breached the law on a strict application (and I am not saying that he did or didn't), there is also a need to be sensible about this. The law is not completely inflexible, nor are judges inhuman. I am relatively confident that if this case was to appear in a court of law the judges would pat Tom on the back and throw the case out. At the end of the day an individual's life was saved and I've not come across a case yet - although the very nature of blogs means that someone will know of case - where an individual has been resuscitated (possibly in contravention of a DNAR order which the ambulance crew were unaware of) who then sued the Ambulance service for their troubles. Don't get me wrong, I believe in the importance of individual autonomy and the need to let fully capable patients make decisions about what treatment they do or do not agree to, but reflecting on Tom's situation I think there are a number of things to take into account: 1) It is easy for anyone who wasn't immediately involved in the situation (and lawyers are particularly guilty of this) to pick through the aftermath of a medical decision with the benefit of hindsight and to question every aspect of the defendant's judgment, but decision making in medical practice does not work like that, you don't have the time to sit back, reflect on the ideal course of action and then act. Delays often cost lives; 2) The law requires an individual to be able to weigh up have an understanding of both the information they are being presented with and the consequences of their decision. Where the consequences of their decision will necessarily be death, the law will expect a higher standard. There seemed nothing to me in the facts presented in Tom's blog which suggested that the patient was actively refusing treatment because they wanted to die. If push came to shove I would suggest that, since the consequences of their decision would have most likely have been death, this would lead me to believe that the individual did not really have the capacity to refuse and Tom was free to treat them in accordance with what he believed to be in that individual's best interests. 3) Tom freely admits that he deceived the patient in order to obtain their consent. Consent obtained by fraud is generally not valid consent, however, in all the cases I have come across where this point has been made the motivation behind the deception had some crinminal element (e.g. deceiving dental patients into consenting to unnecessary treatment in order to boost profits). Regardless of the means used to obtain the patients consent, Tom's motivation here was surely a noble one and I don't believe he would be condemned in the courts for it. 4) I have seen the point made in another posting that guidelines are not the same things as rules. This observation is spot on. Never lose sight of the fact that guidelines cannot possibly cover all circumstances and also that, whilst a failure to adhere to guidelines mey be indicative of a breach of the duty of care owed, a slavish adherence to guidelines when thecourse of action recommended by them was not best suited to the situation is just as bad. I for one would like to think that if I was in the same situation as Tom I would take the same course of action. Likewise I would also like to think that if I was in the same situation as that patient that someone would take the same course of action with me as Tom did. Whether my post takes the debate anyfurther or not is another matter, but I await replies with interest.