Patient challenges GMC guidance on withdrawing treatment
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《英国医生杂志》
BMJ
A man with a degenerative brain condition who claims that the General Medical Council's guidelines would allow doctors to end his life against his wishes took an unprecedented "right to life" case to the High Court in London last week.
Leslie Burke, aged 44, of Lancaster, is seeking judicial review of the GMC's 2002 guidance on withholding and withdrawing life prolonging treatment, which he argues is unlawful because it could lead doctors to breach his human rights.
Leslie Burke: "I may well end up in the position where I need artificial hydration and nutrition... I may not be able to communicate with the doctors"
Credit: JOHNNY GREEN/PA
Mr Burke was diagnosed 12 years ago with cerebellar ataxia and depends on a wheelchair for mobility. His prognosis is that he will remain mentally competent until death is imminent but will lose the ability to swallow.
"I am doing this because I may well end up in the position where I need artificial hydration and nutrition," he explained before the hearing. "Physically my body will deterioate, but I will be mentally alert the whole time.
"I may not be able to communicate with the doctors, and it takes two to three weeks to die when hydration and nutrition is withdrawn, and I will be acutely aware of that every single day and physically not be able to do anything about it."
His counsel, Richard Gordon QC, said the guidance could breach his right to life and his right to be spared inhuman and degrading treatment under articles 2 and 3 respectively of the European convention on human rights.
It could also violate his right to autonomy (article 8) and his right to a fair hearing (article 6) because the convention advises doctors only to seek legal advice on whether they should apply to the court for a ruling before denying artificial nutrition and hydration.
And the distinction between patients in a permanent vegetative state—whose cases need court sanction—and others was discriminatory under article 14 of the convention, said Mr Gordon.
He said the guidance seemed to suggest that artificial nutrition and hydration could be denied by doctors to patients who were fully capable of taking their own decisions.
Dinah Rose, the GMC's counsel, told the judge, Mr Justice Munby, that it would be "entirely inappropriate" to deny artificial nutrition and hydration to a patient in Mr Burke's position. "There is no evidence at all before the court that any doctor has ever proposed, or has any intention of proposing, that should he require artificial feeding and hydration it would not be provided to him.
"There is no suggestion by any doctor that they believe the guidance issued by the GMC might encourage or permit them to withdraw artificial nutrition or hydration from Mr Burke."
She added: "The GMC wishes to make it clear at the outset that we would welcome any assistance this court can give as to ways in which our guidance can be clarified and improved."
Judgment was reserved till later.(Clare Dyer, legal corresp)
A man with a degenerative brain condition who claims that the General Medical Council's guidelines would allow doctors to end his life against his wishes took an unprecedented "right to life" case to the High Court in London last week.
Leslie Burke, aged 44, of Lancaster, is seeking judicial review of the GMC's 2002 guidance on withholding and withdrawing life prolonging treatment, which he argues is unlawful because it could lead doctors to breach his human rights.
Leslie Burke: "I may well end up in the position where I need artificial hydration and nutrition... I may not be able to communicate with the doctors"
Credit: JOHNNY GREEN/PA
Mr Burke was diagnosed 12 years ago with cerebellar ataxia and depends on a wheelchair for mobility. His prognosis is that he will remain mentally competent until death is imminent but will lose the ability to swallow.
"I am doing this because I may well end up in the position where I need artificial hydration and nutrition," he explained before the hearing. "Physically my body will deterioate, but I will be mentally alert the whole time.
"I may not be able to communicate with the doctors, and it takes two to three weeks to die when hydration and nutrition is withdrawn, and I will be acutely aware of that every single day and physically not be able to do anything about it."
His counsel, Richard Gordon QC, said the guidance could breach his right to life and his right to be spared inhuman and degrading treatment under articles 2 and 3 respectively of the European convention on human rights.
It could also violate his right to autonomy (article 8) and his right to a fair hearing (article 6) because the convention advises doctors only to seek legal advice on whether they should apply to the court for a ruling before denying artificial nutrition and hydration.
And the distinction between patients in a permanent vegetative state—whose cases need court sanction—and others was discriminatory under article 14 of the convention, said Mr Gordon.
He said the guidance seemed to suggest that artificial nutrition and hydration could be denied by doctors to patients who were fully capable of taking their own decisions.
Dinah Rose, the GMC's counsel, told the judge, Mr Justice Munby, that it would be "entirely inappropriate" to deny artificial nutrition and hydration to a patient in Mr Burke's position. "There is no evidence at all before the court that any doctor has ever proposed, or has any intention of proposing, that should he require artificial feeding and hydration it would not be provided to him.
"There is no suggestion by any doctor that they believe the guidance issued by the GMC might encourage or permit them to withdraw artificial nutrition or hydration from Mr Burke."
She added: "The GMC wishes to make it clear at the outset that we would welcome any assistance this court can give as to ways in which our guidance can be clarified and improved."
Judgment was reserved till later.(Clare Dyer, legal corresp)