@C7RKY I think it was you who was reading my criticisms of ReSPECT? If it was you, and if you've looked - who do you think is right, ReSPECT or me?
Taking in the consent conversation is a separate, but very valid point. My focus has been on ensuring the record of that conversation remains accurate. Local discretion has its pitfalls. This may help explain a little more. From an email exchange with DoH >pic.twitter.com/rQdhZ3iLr8
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The best way to try and ensure that the record of a conversation is 'accurate' is to get whichever party to the conversation did not write the record, to sign the record to confirm that it appears to be right. BMA/RCN/RC(UK) are resistant to that, however.
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Not in this case, it's not. The signature doesn't make a jot of difference in mitigating the risk I'm talking about here I'm afraid - as acknowledged by CQC/NHSE/GMC. If you read the articles I linked to before, it will hopefully explain more.
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Ah - you are interested in 'remains' accurate?
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Exactly! As opposed to the form being vulnerable to later amended, in order to try and justify any clinical action - or inaction - that was not in keeping with the consent obtained.
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Well - if you design a better form, you would have the problem of the entire form being substituted for a faked one. I suppose you would need to store copies of completed consent forms in a 'trusted third-party repository' as soon as the form was completed? Unlikely to happen.
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3rd party not necessary. Some measures can prevent amendment, but the greatest protection comes from ensuring that the form makes it clear the pt should take their copy immediately after signing it, imho. Can't switch/amend it unnoticed, if the patient has a copy at home.
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Keeping a copy makes sense - but all of this (your issue) is about 'distrust' when you think about why it is necessary: distrust is a very poor foundation for good care/behaviour, especially during end-of-life at home [as I keep pointing out, in BMJ rapid responses].
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1/2 You're right, this stems from being given reason to distrust, but it's also about regulation. My mother & I trusted implicitly however, as most do. And it transpires that it's possible to abuse that trust. Potentially systematically & at scale, when you look at the evidence.
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