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Wednesday, June 23, 1999 Published at 13:03 GMT 14:03 UK


Withdrawing treatment: The reaction

Some groups fear that the guidance could harm patient care

The Pro-Life Alliance is on record as saying that withdrawing nutrition is akin to murder, and that it is an obscenity to consider water and nutrition as medical treatments.

Health: Background Briefing: Euthanasia
Any move towards formalising the withdrawal of treatments is the first step towards the legalisation of euthanasia, it says.

Doctors and euthanasia lobbyists, however, see it as a separate issue to euthanasia and will act as a useful guide to standardise how doctors act in difficult end of life situations.

Dr Michael Wilks, chairman of the BMA's medical ethics committee

"Some people believe passionately that life must be preserved at all costs, but most people and certainly the majority of doctors accept there comes a point when treatment ceases to be of benefit for the patient.

[ image: Dr Michael Wilks:
Dr Michael Wilks: "not euthanasia"
"Death cannot be postponed indefinitely. There comes a point where medical treatments, including artificial nutrition and hydration, are more of a burden than a benefit to the patient.

"I hope that our guidance will reassure patients that these difficult decisions are made thoughtfully and sensitively, in close discussion with relatives.

"We recommend that any decision to withdraw artificial nutrition and hydration should be reviewed by a senior doctor from outside the immediate team and I believe that both doctors and families will find this helpful and reassuring."

Mike Willis, chairman of the Pro-Life Alliance

"It's a disturbing but expected development - they are trying to widen the ground following the Bland ruling.

"The BMA is trying to extend the number of cases where you do not need a court order to end treatment - it opens the floodgates to euthanasia.

"As for this idea of considering hydration as a treatment, it's a basic human need and you wouldn't deny it to a dog.

"And as for consulting relatives, all sort motives come into play in ending the life of an individual.

"This is a benchmark recommendation in terms of the introduction of involuntary euthanasia into this country. Involuntary euthanasia will become accepted practice in the hospitals of the UK.

"There's a big push on at the moment to get euthanasia at the top of the agenda."

Dr Sam Everington, an East London GP and a member of the BMA's ethics committee

He said doctors are rightly nervous about acting in what they believe is their patient's best interests for fear that prosecution or disciplinary action could follow.

He said that clear guidance could prevent doctors carrying on pointless treatment, and allow patients to "die with dignity".

The key point, he said, was teamwork - so a doctor would make the decision together with relatives and colleagues.

He said: "Very often, things go wrong because there is no proper consultation before the decision is made.

"I think the British people are very interested in end-of-life issues - there is never a problem when I discuss it with people."

Janet Allen, of 'SOS-NHS Patients in Danger'

"Giving water is not treatment - that's not a medicine, it's the stuff of life.

"If water is withheld or fluid is withheld, death is inevitable."

Jenni Burt of the Voluntary Euthanasia Society

She said the guidelines were "very sensible", although they were not directed at introducing euthanasia.

Instead, they would be invaluable at letting doctors know where they stood, she said.

"What the BMA is doing is stepping into a gap. If the patient hasn't made their wishes known, if they haven't made a living will, this allows doctors in association with the relatives and family to make the right decision about whether treatment should be withdrawn.

"The guidance will help doctors immensely because it's such a grey area at the moment - doctors have been making very different decisions.

"A doctor in one area may be happy to withdraw artificial feeding from a severe stroke victim who's not going to recover," she said.

"But in another area a patient in the same position may be artificially kept alive for months or even years because that doctor is uncertain about where they stand.

"These guidelines will standardise that and will ensure that every doctor is working within the same framework."

Jamie Bogle, barrister

"In fact, the guidelines do not refer only to patients who are dying.

"It may also refer to a serious long-term chronic state.

"The problem here is that we are talking about withdrawing food and fluids and because in the very narrow circumstances of persistent vegetative state that has been redefined as treatment, what these guidelines will do is widen it right out into a whole range of conditions, many of them non-terminal, in which we will be talking about intentionally terminating a patient's life by dehydration. That must be wrong."

Dr Andrew Fergusson, chairman of Healthcare Opposed to Euthanasia

"While I welcome the implicit recommendation for an increasing recognition of the inevitability of natural death, I am deeply concerned that some doctors might interpret the guidelines to increase the number of unnatural deaths.

"I recognise these are very difficult matters, but am anxious about even more power being given to doctors in the apparent absence of adequate safeguards.

"This guidance will be bad for some patients."

Dr Liam Fox, Shadow Health Secretary

"The only acceptable ethical basis for any decision is whether a particular course of action is to the benefit of the patient.

"This is clearly a very difficult area of medicine and I welcome the BMA's new guidance."

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