Wednesday, June 1, 2005
The Los Angeles Times reports that a British man with a degenerative brain condition has filed suit demanding that the state give him nutrition and water to stay alive once he is no longer able to feed himself, even if the quality of his life might seem poor to an outsider. His condition will incapacitate him in 15 to 20 years. The lawsuit is in response to the the General Medical Council, the body that oversees medical licensing, which issued a "guidance" that allows doctors to withhold or withdraw life-prolonging treatment if they deem a patient's condition so severe and his prognosis so poor that artificial feeding would be more of a burden than a benefit. A doctor may do so even against a patient's expressed wishes.
Trial court Judge James Munby ruled for the patient, Leslie Burke, reasoning that a competent patient should be able to make such a decision. According to Bloomberg.com, Burke won the right to have artificial nutrition continued even when he can no longer physically communicate his wishes. The judge ordered the Genral Medical Council to revise the guidelines. On appeal, the Medical Council argued that the judgment could be interpreted to mean that patients had the right to demand treatment doctors didn't believe was in the patients' interests. The Council wants more guidance on how the High Court judgment applies to other forms of life-saving treatment, such as antibiotics or respiratory intervention, and on what basis a doctor can withdraw treatment if a patient has not given any instructions. As reported by the BBC and others, Burke's lawyers argue that the guidelines contradict the European Convention on Human Rights, which protects a person's right to life.
In an interview with the BBC World Service Radio, Sharon Burton -- an advisor at the General Medical Council -- argued that
there should be a partnership decision making between doctors and patients, just as Mr. Burke's lawyer is suggesting...We agree that it is the doctor's role to make the clinical judgments about which treatments are appropriate and should be offered to patients, and it is for patients who are competent and able to make their own choices, to make judgments about any quality of life considerations.
In an editorial in the British medical journal BMJ (extract), Raanan Gillon, a distinguished emeritus professor of medical ethics, opined that the judgment, if not overturned, will likely skew medical care by tilting the balance of medical practice towards non-beneficial and wasteful provision of life prolonging treatment in general. [tm]