British Doctors Want the Last Say over Patients' Lives

July 7, 2008 - 7:02 PM

(CNS) - Debate is raging among British health care professionals over newly-issued guidelines that say doctors should have the power to overrule families' wishes to keep a seriously ill patient alive.

The British Medical Association says the decision to withhold or withdraw treatment should be the doctor's - although ideally relatives and, if possible, the patient, should be closely involved. If there is a dispute, a court can be asked to rule on the matter.

"Clearly, where patients are competent, they are the best judge of what represents an acceptable level of burden or risk," the BMA guidelines say.

"But where patients are unable to express their wishes, doctors, in consultation with relatives and other carers, have to decide whether providing life-prolonging treatment would be in their best interests."

They add: "Where a particular treatment is no longer benefiting the patient, continuing to provide it would not be in the patient's best interests and, indeed, might be thought to be morally wrong."

Not all of the BMA's 120,000 members are happy with the advice contained in the document Withholding and Withdrawing Life-prolonging Medical Treatment, which has received widespread publicity in British media.

Possibly most contentious is the fact that "medical treatment," in British common law, includes the administration of food and water when given through a tube - as opposed to by mouth, which is considered "basic care," and can as a result not be withheld.

According to the new guidelines, however, even nutrition administered via a tube should be withdrawn under certain circumstances.

Some BMA members are planning to challenge the guidelines at the association's annual meeting, in Belfast next month.

The BMA's Worcestershire division, for example, intends to push for a motion saying nutrition and hydration should not be withheld from patients who are not terminally ill.

BMA public affairs officer Nigel Duncan told Friday the document had been published "after a lengthy period of widespread consultation." More than 2,000 organizations and individuals have offered input over the last year.

"Predictably there has been a mixed reaction - with significant support and some fierce criticism from the interest groups."

Duncan said the association was "watching to see how reaction develops" in the run-up to the annual meeting on July 8, when members will debate the issue.

Several pro-life and anti-euthanasia groups have voiced concern about the guidelines, and one held a demonstration outside BMA offices in London.

In a bid to pre-empt criticism, BMA ethics committee chairman Dr. Michael Wilks told a press conference the document was "not about euthanasia" or about "intentionally ending a life."

He said it aimed at providing guidelines on the "benefits of particular treatment and whether that treatment should be withdrawn or withheld.

"Death cannot be postponed indefinitely," he said. "There comes a point where treatments, including artificial nutrition, are more of a burden than a benefit to the patient."

According to the guidelines, several factors determine whether particular treatment will benefit the patient. They include the patient's "wishes and values," the views of family and health carers on what the patient would want, and a clinical assessment of the effectiveness of the proposed treatment.

"The main focus of the new guidance is decisions about patients who are likely to live for weeks, months, or possibly years, if treatment is provided but who, without treatment, will or may die earlier."

British police are investigating up to 60 cases in which doctors are suspected of withholding intravenous drips from dehydrated patients - many of whom were not terminally ill.