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 A second medical opinion must sought before hydration and nutrition is withdrawn.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.
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.
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.”