BMJ editorial sparks controversy over right-to-life

18 July 2012 by

An editorial article published in the British Medical Journal on 12 July 2012 (subscription required) has provoked controversy in right-to-life circles. The article, entitled “Sanctity of life law has gone too far” criticises the ruling of Baker J in the “M” case where an application to authorise the removal of artificial nutrition and hydration (ANH) from a patient in a minimally concscious state was refused. This blog reported on the M judgment in September 2011 here, here and here.

The author of the BMJ article, Dr Raanan Gillon, Emeritus Professor of Medical Ethics at Imperial College London (who describes himself as “a hybrid GP and philosopher”) takes Baker J to task for not according significant weight to the informally expressed views of M on life-sustaining treatment, expressed before she came ill. More widely, Dr Gillon questions the implications of the judgment for decisions about the best interests of patients whose state of consciousness is higher than minimal. Most controversial of Dr Gillon’s comments is likely to be his conclusion on the resource implications of the approach to best interests of incapacitated patients, which is put in the following terms:

“The logical implications of this judgment threaten to skew the delivery of severely resource limited healthcare services towards providing non-beneficial or minimally beneficial life prolonging treatments including artificial nutrition and hydration to thousands of severely demented patients whose families and friends believe they would not have wanted such treatment. The opportunity cost will probably be reduced provision of indisputably beneficial treatments to people who do want them.”

This has been paraphrased by one commentator as a call to “Dehydrate dementia patients to death to save money”.

Dr Gillon concludes that “Unless this judgment is overturned or modified by a higher court it will gradually and detrimentally distort healthcare provision, healthcare values, and common sense.”

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1 comment;

  1. Nicholas Dove says:

    This is an area fraught with potential for abuse, however,
    1)where a patient has expressed their wish in a clear and unambiguous way, whilst still mentally competent, it should be taken as a direct instruction, and refusal to follow the instruction should be regarded as the deliberate infliction of cruelty, constituting physical abuse.
    2)It should not be necessary to prepare a legal document, a simple letter of intent, witnessed by two completely independent witnesses who are not in a position to benefit from the death of the person concerned.
    3) It should however not be compulsory for a doctor to carry out the necessary procedure if there is an objection on religious grounds or moral grounds by the individual doctor.
    4) A conscientiously objecting doctor should not however be able to block another doctor from taking the necessary measures
    5) It may be advisable to establish a central impartial database where an individual may register their intentions, as a double check against potential fraudulent actions either by someone opposed to the decision, or trying to fraudulently claim that the decision was expressed by the person involved using a forged document.

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