Man wins battle to keep receiving life support
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《英国医生杂志》
A terminally ill man who feared doctors might one day stop feeding him has won a landmark judgment ensuring that his wish for life supporting treatment will be respected.
Leslie Burke, aged 44, from Lancaster has degenerative cerebellar ataxia and is likely to lose the ability to communicate. He sought judicial review of the General Medical Council's 2002 guidance on withholding and withdrawing life prolonging treatment, arguing that it breached articles 2 and 3 of the European convention on human rights—the right to life and the right to be spared inhuman and degrading treatment.
Mr Burke objected to clauses in the GMC guidance that could permit doctors to withdraw artificial nutrition or hydration from a patient in cases where doctors judged that the patient's quality of life was very poor, even if a living will requested continued life support.
Mr Justice Mumby praised the GMC's overall guidance, calling it a "compelling piece of work" and a "document whose contents, indeed whose whole approach, should greatly reassure patients and their relatives." But he ruled that in cases where the patient has previously expressed a wish for continued life support, the guidance was "unlawful" in permitting doctors to withdraw treatment when they consider it would be "intolerable" from the point of view of the patient's welfare.
Sharon Burton, the GMC's senior policy adviser, said: "It is our stated position that in cases where there is disagreement over the care of a patient, the courts should be approached for a ruling. It is again helpful that Justice Mumby has provided a list of situations where this is necessary in cases involving artificial nutrition and hydration. We are also glad that Justice Mumby confirms, as we have said, that Mr Burke is entitled to have his wishes followed.
"As the case raises important points of principle, and there are some areas where we consider further clarification may be needed, we have sought leave to appeal." Unless the appeal succeeds, the GMC will have to redraft its guidance on withdrawing life prolonging treatment.
After the hearing, Mr Burke said: "My communication and speech is already deteriorating and is a problem now. Further down the line, I won't be able to communicate my wishes either way, and this could just be withdrawn without my consent. In a civilised society, it can't be right to allow vulnerable people to effectively starve to death."
Bert Massie, chairman of the Disability Rights Commission, which intervened in the case as an interested party, said: "This judgment provides genuine protection for disabled people with serious long term conditions. Until now doctors had the power to refuse or withdraw life prolonging treatment and to disregard a disabled person's wishes based, in some cases, on a set of assumptions that disability equals a very poor quality of life."(Owen Dyer)
Leslie Burke, aged 44, from Lancaster has degenerative cerebellar ataxia and is likely to lose the ability to communicate. He sought judicial review of the General Medical Council's 2002 guidance on withholding and withdrawing life prolonging treatment, arguing that it breached articles 2 and 3 of the European convention on human rights—the right to life and the right to be spared inhuman and degrading treatment.
Mr Burke objected to clauses in the GMC guidance that could permit doctors to withdraw artificial nutrition or hydration from a patient in cases where doctors judged that the patient's quality of life was very poor, even if a living will requested continued life support.
Mr Justice Mumby praised the GMC's overall guidance, calling it a "compelling piece of work" and a "document whose contents, indeed whose whole approach, should greatly reassure patients and their relatives." But he ruled that in cases where the patient has previously expressed a wish for continued life support, the guidance was "unlawful" in permitting doctors to withdraw treatment when they consider it would be "intolerable" from the point of view of the patient's welfare.
Sharon Burton, the GMC's senior policy adviser, said: "It is our stated position that in cases where there is disagreement over the care of a patient, the courts should be approached for a ruling. It is again helpful that Justice Mumby has provided a list of situations where this is necessary in cases involving artificial nutrition and hydration. We are also glad that Justice Mumby confirms, as we have said, that Mr Burke is entitled to have his wishes followed.
"As the case raises important points of principle, and there are some areas where we consider further clarification may be needed, we have sought leave to appeal." Unless the appeal succeeds, the GMC will have to redraft its guidance on withdrawing life prolonging treatment.
After the hearing, Mr Burke said: "My communication and speech is already deteriorating and is a problem now. Further down the line, I won't be able to communicate my wishes either way, and this could just be withdrawn without my consent. In a civilised society, it can't be right to allow vulnerable people to effectively starve to death."
Bert Massie, chairman of the Disability Rights Commission, which intervened in the case as an interested party, said: "This judgment provides genuine protection for disabled people with serious long term conditions. Until now doctors had the power to refuse or withdraw life prolonging treatment and to disregard a disabled person's wishes based, in some cases, on a set of assumptions that disability equals a very poor quality of life."(Owen Dyer)