LONDON, England / The Telegraph / Lifestyle / Health Care / May 19, 2010
Doctors could be struck off if they fail to respect the wishes of terminally ill patients who want to die by refusing treatment, the General Medical Council is to announce.
By Kate Devlin, Medical Correspondent
Doctors must also follow the wishes of patients as communicated through a friend or relative who has been designated their “legal proxy”, says the GMC.
A doctors’ group and pro-life campaigners expressed unease over the guidance, which is published today, and suggested that it had gone too far.
It is a response to new laws such as the Mental Capacity Act 2005, which gave “living wills” legal status. Last year, the case of Kerrie Wooltorton, 26, provoked controversy after she used a “living will” to order doctors not to save her after she poisoned herself.
The guidance makes clear that the directives can be ignored only where there is evidence that a patient may have changed his or her mind. It also says doctors must respect the wishes of patients who make their feelings clear verbally, provided they are mentally capable of doing so.
Doctors must not let their own personal or religious objections interfere — although they can withdraw from treating an individual patient — and must seek a second medical opinion before withdrawing hydration and nutrition.
The guidance states: “Following established ethical and legal (including human rights) principles, decisions covering potentially life-prolonging treatments must not be motivated by a desire to bring about a patient’s death and must start with a presumption in favour of prolonging life.
“This presumption will normally require you to take all reasonable steps to prolong a patient’s life.
“However, there is no absolute obligation to prolong life irrespective of the consequences for the patient, and irrespective of the patient’s views, if they are known or can be found out.”
Doctors who flouted the guidelines would be forced to attend a fitness to practise hearing before the GMC and would be struck off if the case against them were proved. The rules affect patients deemed to be mentally capable of making these decisions. If they do not have this capacity, or have not designated someone to act on their behalf, doctors are required to make any judgment about treatment in the best interests of the patient. The guidance says that in these cases, when the decision over end of life treatment is “finely balanced”, the patient’s previously stated wishes “will usually be the deciding factor”.
Dr Peter Saunders, of the Christian Medical Fellowship, said many patients nearing the end of their lives could not articulate a change in their wishes. “We must beware of the danger of allowing a hastily-drafted and ill-informed advance refusal to trump good clinical judgement,” he said.
“Most people believe that there could be times when their best interests would be best served if clinicians ignored their directive. We trust therefore that the GMC will look kindly upon doctors who, for good clinical and ethical reasons and with the very best interests of the patient at heart, choose on occasions not to follow them.”
Dominica Roberts, the chairman of the Pro-Life Alliance, said: “Everybody has the right to refuse treatment. But feeding and hydrating a patient, even artificially, is not treatment, it is care.”
The rules also detail what doctors should do if a patient wants a treatment to continue when there might not be any medical justification for it. The guidance states that if a patient requests that a treatment — such as artificial feeding — should continue right up until their death, a doctor can overrule these wishes if they feel it would offer no benefit and cause the patient discomfort or harm.
Dr Tony Calland, of the British Medical Association, which was involved in developing the guidance, said: “We believe the GMC’s guidance is clear about the need to work with the patient to ensure that they are treated fairly, with dignity and without prejudice.”
Prof Jane Maher, of Macmillan Cancer Support, welcomed the guidance. “It is crucial that doctors work in partnership with cancer patients at or nearing the end of their lives,” she said.
Michelle Mitchell, from Age UK, said: “Some 80 per cent of people that die every year are 65 and over, yet older people often experience undignified and poorly planned care at the end of life.
“This guidance highlights the need for doctors to identify people who are nearing the end of life, so they can effectively plan care in partnership with patients and their families.” [rc]
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