Abstract
Crews et al. 1 have summarised the current state of legislation surrounding deprivation of liberty standards (DOLS) and its impact on intensive care. They acknowledge that the law was not intended for use in the intensive care setting, but confirm that we must comply with it. The key issue is in determining at what point in routine care of an unconscious patient should a DOLS application be made. They give the example of a patient (P) who is unconscious after a hypoxic brain injury and in their view a DOLS must be applied for.
The “acid test” requires that a patient is “not free to leave” and Crews et al. 1 suggest consideration of what actions we would take if “family members sought to remove them”. They argue that patient P is not free to leave. I think there is a possible different interpretation of this and I would argue that patient P is free to leave. If the family sought permission to remove patient P and care for them at home I would not object. Should they actually request this they would need to satisfy me that they could care for him, but “in principle” there would be no objection. More realistically, they may wish to transfer him to a different healthcare facility and there would be no objection to this. This is in contrast to a similar patient previously incarcerated in prison who would not be “free to leave” irrespective of the family’s wishes.
The legislation is not designed for critical care and in my view we simply need to interpret it in a way that is legal but not burdensome. The care of the patient will not differ irrespective of interpretation.