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Sunday, July 5, 1998 Published at 17:19 GMT 18:19 UK


Doctors face ethical dilemmas

Doctors facing more and more ethical questions

Doctors' leaders have launched a major public consultation on the ethical dilemma of whether to withdraw or withhold treatment from patients who have no prospect of recovery.

Dr Michael Wilks, the BMA Ethics Chairman, on the need for uniformity
The British Medical Association has published guidelines to help doctors, nurses and carers make decisions on questions such as when to withdraw food and water from dying patients and whether children should be subjected to new, experimental operations which carry a high risk.

The guidelines aim to encourage a public debate on the issue.

The 30-page consultation paper goes over the main cases which have caught media attention and highlights current practice and law.

Court rulings

In some of the more controversial cases, the courts have been asked to rule on whether treatment could be withheld.

These include that of Laura Davies, a four-year-old who died after being subjected to multiple organ transplant and student Catherine Roberts who won a 100,000 out of court settlement after recovering from a coma two months after doctors had decided to withdraw nutrition.

Doctor Vivienne Nathanson, the BMA's Head of Ethics, said there was "a great deal of confusion" surrounding the issue.

"An awful lot of cases are going to court at the moment and the big question is whether that is desirable," she said.

"Do the courts feel able to make decisions and do the families feel it is dehumanising for the courts to make decisions about loved ones when they actually want to discuss this in private with doctor and carers?"

The BMA consultation document says doctors should not be pressurised into agreeing to wholly experimental treatments and that risky treatments should not be used on children unless they have first been tried on consenting adults.

Dr Nathanson said :"It's always an extraordinarily difficult thing for doctors. Some parents will want to seize any and all opportunities to prolong the life of their child however extreme, risky, traumatic and even experimental the treatment is.

"The role of the doctor is to try to make it clear to the parents what the risks and opportunities are for that child, but doctors must not be forced into offering treatment that is wholly experimental."

BMA secretary Dr Mac Armstrong said: "Doctors should not be involved in 'cookbook medicine', simply following protocols, but neither should they have to take decisions in isolation that could be contradicted later in the courts.

The questions raised by the BMA include:

  • How do you decide what a patient's best interests are if they have not made their wishes clear before suffering an accident or becoming mentally incapacitated?
  • Should the courts be involved in problematic cases or could decisions be made by the patient's family or their health care team?
  • Are there different principles at stake for children and adults?
  • Should the views of blood relatives carry more weight than those of others?

A wide range of organisations will be consulted by the BMA including patients and legal and religious groups. The document is also being posted on the internet at

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