The British Medical Association and Royal College of Physicians have published new guidance, endorsed by the General Medical Council, on decision-making about clinically assisted nutrition and hydration and adults who lack capacity to consent. The development of the guidance follows a series of legal cases which has created confusion about the precise circumstances in which an application to the court is required before CANH is withdrawn which has culminated with the decision of the Supreme Court in National Health Service Trust (...) versus Y. 1 This confirmed that there is no requirement to go to court, providing there is agreement as to the patient’s best interests, the provisions of the Mental Capacity Act 2005 have been observed, and the relevant professional guidance has been followed. The new guidance covers all decisions to start, restart, continue, or stop providing CANH in patients who are not imminently dying, in circumstances where CANH is the primary life-sustaining treatment being provided. It goes beyond the category of patients in permanent vegetative state or minimally conscious state who have previously been the subject of court applications, and also covers decisions for patients with neurodegenerative conditions and patients who have suffered a sudden onset brain injury in addition to having multiple comorbidities or general frailty which is likely to impact on life expectancy. It provides a clear statement of doctors’ legal responsibilities, covers the importance of robust best interests’ assessments and sets out the process to be followed for sufficient independent scrutiny of decisions. In light of some of the identified problems with decisions about CANH, a particular focus of the guidance is on the importance of regular best interests’ assessments, and it provides detailed practical guidance about how to approach these. The development of …. (shrink)

In mid-2018, following a survey of lesbian, gay, bisexual and transgender groups, the UK government issued a consultation on the proposed reform of the Gender Recognition Act for England and Wales.1 When it was first introduced in 2004, the GRA was considered innovative, even world-leading legislation.2 The act enables any adult to seek to change their legal gender provided several criteria are met. These include: If the applicant is successful, he or she is issued with a ‘gender recognition certificate’, their (...) birth certificate is changed and ‘for all purposes’ they become, legally, their acquired or affirmed gender. Since 2004, cultural change in relation to gender identity has been rapid. During the government’s preliminary survey, several concerns were raised about the GRA, particularly among those who have changed, or who may be seeking to change, their gender. These included: The government has stated that being trans is not a mental illness—more a fact of human diversity. It points to the World Health Organisation’s revision of the International Classification of Diseases, in which ‘gender incongruence’, another term for gender dysphoria, is no longer classed under ‘mental and behavioural disorders’.3 ### Draft proposals for change The government considers the reform of the GRA …. (shrink)