Storm as doctors are told: Choose if patients live or die
Removing feeding tubes ‘is euthanasia by stealth’
DOCTORS will be able to decide to end the lives of patients with severe dementia or other degenerative diseases if proposals from their own leaders are adopted.
The guidelines say consultants or GPs should be allowed to remove tubes giving food and water to those who cannot feed themselves – even if they could otherwise live for years.
However, the British Medical Association’s draft ruling to withdraw nutrition and hydration tubes was condemned as ‘euthanasia by stealth’ yesterday.
The BMA’s document follows legal test cases in which judges ruled that NHS staff no longer need a court’s permission to withdraw artificial nutrition and hydration from a patient who is incapacitated and unable to speak or feed themselves.
Last month, the Supreme Court backed the right of doctors to end ‘clinically-assisted artificial nutrition and hydration’ as long as they had the agreement of a patient’s family.
Removal of the tubes means that an incapacitated patient will die of thirst and starvation.
The BMA said doctors should be able to end the lives not only of patients close to death or in deep comas, but of patients with more common degenerative conditions, including advanced dementia.
Around 850,000 people are thought to have dementia in Britain, with the figure expected to exceed a million by 2025.
It claimed the proposal should cover ‘those patients who have a recognised degenerative condition – such as advanced dementia, Parkinson’s or Huntington’s disease – that is likely to result in the patient being unable to take sufficient nutrition orally’.
It added: ‘Due to the degenerative nature of their condition, these patients are on an expected downward trajectory and will inevitably die, usually as a result of their underlying condition, although perhaps not imminently and could go on living for years.’
Stroke patients and those with ‘rapidly progressing brain injury’ could also be included.
Decisions on removing nutrition and hydration tubes should be taken by consultants for hospital patients, or GPs for those in nursing or residential homes or living in their own homes.
However, families or friends should be consulted, but would not have the final decision.
But doctors and campaigners opposed to euthanasia and the deliberate termination of life by medical staff criticised the suggestion last night.
Dr Peter Saunders, of the group Care Not Killing, said: ‘ This is a recipe for euthanasia by stealth, but all in the name of autonomy and best interests – the very worst kind of doctor paternalism justified on the grounds that the patient would have wanted it.
‘There are conceivably tens of thousands of patients in England and Wales who are vulnerable to the abuse of this guidance. It will be almost impossible to work out what has happened in a given case and there are no legal mechanisms for bringing abusers to justice.’
Professor Patrick Pullicino, of East Kent Hospitals University NHS Trust, who helped expose hospital deaths under the discredited Liverpool Care Pathway, said the proposals were ‘terrible’.
He added: ‘It codifies practices of withdrawing food and fluid at end of life and thereby encourages it. It facilitates the extension of end- of-life pathways to people with neurological diseases who are not dying – a very negative thing.’
The BMA said that in cases where patients die after the withdrawal of nutrition and hydration, this should not be mentioned on death certificates, with only the underlying original condition given as the cause of death.
Professor Pullicino said this ‘directs doctors to falsify death certificates’, adding: ‘It will conceal the statistics of patients who are being dehydrated to death.’
Doctors are told that to decide whether a patient’s best interests lie in dying they should consider the chances that their condition will improve, what their quality of life is, and what their views on whether they wish to live on in their condition are likely to be.
The test case that allowed doctors to decide patients should die was made by the Law Lords in 1993. They said 22-year-old Tony Bland, a Liverpool FC fan who received brain injuries at Hillsborough in April 1989, should be allowed to die. This defined artificial nutrition and hydration by tube as treatment that could be stopped if it was not in a patient’s interest to be treated.
In 2005, the Mental Capacity Act said nutrition and hydration should be withdrawn if an incapacitated patient left a living will.
The BMA document was circulated in June following court rulings in 2017 which, it said, meant there was no requirement for court approval before removing nutrition and hydration tubes.
Last month, the Supreme Court ruled in the test case of a person known as Y that doctors can let a patient die without court guidance. A BMA spokesman said decisions about withdrawing clinically-assisted nutrition and hydration (CANH) presented ‘clinical, ethical and legal challenges’. He added: ‘Following legal developments, the BMA has been working with the Royal College of Physicians and the General Medical Council to produce guidance.
‘CANH is a form of medical treatment. The aim of medical treatment is not simply to prolong life at all costs, and the courts have been clear that in some circumstances it will not be in the best interests of patients to receive it.’
He said the final version of the guidance would reflect the latest Supreme Court ruling.
‘Vulnerable to abuse’
THIS paper is deeply uneasy over draft guidelines saying doctors should have the right to deny nutrition to patients who might otherwise live for years.
It began with a call for the right to end the lives of those close to death or in deep comas. Now the BMA wants to extend doctors’ power to hasten the end for patients suffering from acute dementia, Parkinson’s or Huntington’s disease.
The chilling question is: who will be next? The Mail urges the BMA to remember the Hippocratic Oath – ‘first, do no harm’ – and think again.