GMC to announce policy of striking off doctors who prolong the lives of terminally ill patients against their wishes [updated]

If a terminally ill patient has made a “living will”, specifying in advance that they do not want to be resuscitated, doctors must respect these wishes or risk being struck off. The General Medical Council is to announce this guidance in response to the Mental Capacity Act 2005 which gives “living wills” legal status. Doctors must not follow their own personal or religious convictions by prolonging treatment unless there is evidence that a patient may have changed his or her mind.

Update 25/05/10 – The Guidance has been published and can be found here

If a doctor is unwilling to follow the express verbal instructions of a patient – communicated through a friend or relative as legal proxy — they can withdraw from treating the individual. A second medical opinion must sought before hydration and nutrition is withdrawn. Telegraph Medical Correspondent Kate Devlin reports that

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”.

This very humane step reflects a sea change in the attitude of the medical regulators to the much-debated right to die with dignity. Although there is nothing radically new in this guidance – it has always been unlawful for doctors treat a patient against their wishes – the imposition of a specific sanction in the regulations is a welcome clarification of the ethical position. It will have far reaching implications, not only for people suffering from terminal medical illness, but cases where the harm is self-inflicted (provided of course that the individual concerned has made his or her wishes known). In her article Kate Devlin recalls the case of Kerry Wooltorton last year, who at 26

provoked controversy after she used a “living will” to order doctors not to save her after she poisoned herself.

The doctors were likely to have been able to save her life, but they were powerless to do anything more than make her comfortable because she had set out her wishes in advance. So if you can render yourself terminally ill, and avoid resuscitation by means of a living will, where does that leave the law on assisted suicide? After all, the idea that felo de se is the ultimate symptom of an unbalanced mind is no longer current. As Terry Pratchett observed in his powerful and moving Dimbleby lecture ,
a person may make a decision to die because the balance of their mind is level, realistic, pragmatic, stoic and sharp. …In short, their minds may well be in better balance than the world around them.
Put another way, if this enlightened move means that patients who have deliberately taken themselves to death’s door do not have to have their lives prolonged because of medical ethics, why should the law deal differently with the those who have responded to the request of a terminally ill friend or relative who because of their condition need assistance to lift the hemlock to their lips?
The clarification the DPP criteria under which an individual will be prosecuted for assisting in another person’s suicide which followed Diane Purdy’s victory in the House of Lords ( litigation which was itself set in train by the case of Diane Pretty) falls short of the reform in the law relating to voluntary euthanasia sought by many in this country. Such reform will come about, but only by a process of small steps such as these which is why the news from the GMC is so significant. Again, Terry Pratchett may have presaged such a move:
Back in my early reporting days I was told that nobody has to do what the doctor tells them. I learned this when chief reporter George Topley slung my copy back at me and said, “Never say that a patient has been ­released from hospital unless you are talking about someone who is being detained on mental grounds. The proper word is ‘discharged’, and even though the staff would like you to believe that you just can’t walk out until they say so, you damn well can. Although, generally speaking, it’s best not to be dragging a portable life support system down the steps with you.”
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