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EDITIONS
Euthanasia Tuesday, 28 November, 2000, 16:14 GMT
A doctor's dilemma
Doctors face difficult decisions in the course of their duties
The British Medical Association does not support voluntary euthanasia.

It does, however, recognise the complexities surrounding end-of-life issues, particularly the withdrawal or withholding of treatment - what some campaigners call "passive euthanasia".

A central problem is that few people can definitively identify who is responsible for death when treatment is withdrawn.

The association's medical ethics committee has published a discussion paper on the issue, and, as part of that discussion, examines the related "contentious moral questions".

It says: "The BMA is aware that decisions about withholding or withdrawing treatment raise some of the most contentious moral questions faced by society. Like other sectors of society, the medical profession encompasses a wide range of moral views.

"Preoccupied primarily by the need to do the best for the individual patient, doctors have differing views about how that can be achieved. Most accept that there is no absolute duty to prolong life at all costs since death is an inevitable reality.

"The point at which treatment becomes excessively burdensome for a patient must be judged on a case by case basis."

Making decisions

It also examines how problematic cases can be resolved. Some cases - such as the recent David Glass case - end up in the High Court, leading to additional emotional distress for the parties involved and expense for the health service.

"Concern is often expressed that any form of 'problematic' case is taken to the courts for resolution," the document says.

"While it is broadly recognised that some withdrawing or withholding decisions are so serious and problematic that external monitoring of the decision-making process is essential, there is also a feeling that in most cases decisions could be safely taken by caring relatives and conscientious health professionals."

The committee points out that the law will often govern how doctors act.

"We recognise, for example, that competent, informed patients can legally refuse any form of life support.

"If a patient wishes to turn off his or her life support and is physically able to do so, health professionals may not legally override the patient's wish and turn the machine back on.

"In 1994, an inquest decided that doctors had properly discharged their duty of care by not reconnecting ventilation tubes which a patient had repeatedly attempted to remove, even though this resulted in the patient's death.

"Since the patient's wish was clear, the doctors had given the patient a painkiller, diamorphine, after he disconnected the tube.

Disagreement

"The patient's wife contested the validity of his apparent refusal but there was no evidence of his mental capacity being impaired.

"The jury returned a unanimous verdict of death by natural causes after the coroner said that a suicide verdict would be inappropriate. Nor were the doctors deemed negligent for failing to continue treatment to sustain life.

"If, however, the patient were physically incapable of carrying out the wish to turn off mechanical life support and asked health professionals to do this, the question has been raised as to whether their compliance would be judged 'an action causing death'.

"Lawyer Jonathan Montgomery argues that one conclusion that could be reached is that health professionals in such cases are not only permitted to turn off life support when a patient demands it, but are required to do so.

"The counter-argument that might be made is that this action might constitute assisting the patient's suicide although that is not likely to be the view taken by the courts in cases where the patient's competence is not in doubt."

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16 Nov 98 | Health
22 Oct 98 | Health
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