Rights and Biomedicine 1997. A supplement to the European Convention on
Human Rights, this second Convention resolves to take such measures as are necessary to safeguard human dignity and the fundamental rights and freedoms of the individual with regard to the application of biology and medicine' [12]. Article 642) insists thatthe opinion of a minor shall be taken into consideration as an
increasing determining factor in proportion to his or her age and degree of
maturity'. A violation of this Article, while not actionable by itself, could be chal-
lenged in proceedings brought to enforce a European Convention on Human
Rights provision.
10.2.4 Case study
Three years ago, Bushra, then aged 12, underwent chemotherapy and a bone
marrow transplant to treat her leukaemia. Although her condition improved
temporarily, it has now deteriorated again and a second bone marrow transplant
has been proposed. Bushra refuses to consent to the operation because she does
not believe that it will be successful and because she dreads the isolation and the
side effects of the chemotherapy. She understands that she will die without the
transplant. Bushra's mother consents to the intervention.
Strictly speaking, the health care team can proceed on the basis of Bushra's
mother's consent. The team is, however, reluctant to do so in view of Bushra's age,
the strength of her objections, and her understanding of the situation based on her
earlier experience of treatment. The decision is taken to contact the High Court,
which in turn arranges legal representation for Bushra. Her views are conveyed to
the High Court judge dealing with the case. After weighing them up carefully, and
balancing them against the evidence as to the chances of Bushra's health
improving, he decides to override her wishes and authorises the bone marrow
transplant. He provides a full record of his reasons so that Bushra will be able to
read and follow his thinking for herself. Before and after the transplant, Bushra's
nurses will need to help her come to terms with what has happened.
10.3 Adults able to make their own decisions
10.3.1 Refusal of treatment
Where adult patients are critically ill, the temptation to intervene on their behalf
regardless of their wishes may be hard to resist. But even life-threatening condi-
tions do not validate non-consensual treatment. The UKCC warns registered
practitioners against assuming that only they know what is best for the patient'. Instead, patients who reject proposed treatment should be encouragedto realise
that they are capable of deciding what is in their own best interests' [13]. A
summary of the discussions and decisions should be kept with the patient's
records [14].
The courts have repeatedly asserted the right of patients to reject medical
procedures in any circumstances. However, faced with a refusal to consent to life-
saving treatment, nurses, in common with other health care professionals, should
202 Nursing Law and Ethics