Court rules in favour of GMC's guidance on withholding treatment
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《英国医生杂志》
The General Medical Council last week won its appeal against a high court judgment that doctors feared could have forced them to provide futile or harmful treatments if patients demanded them.
The judgment, from Mr Justice Munby last July in the case of Leslie Burke, who has the degenerative disease spinocerebellar ataxia, was hailed as a landmark ruling for patients' rights.
Mr Burke had challenged the GMC's guidelines on withholding and withdrawing life prolonging treatments. He feared that when he reached the point where he could no longer communicate his wishes doctors would decide that his quality of life was too poor to continue artificial nutrition and hydration (ANH) and allow him to die of starvation and thirst.
Mr Justice Munby had pronounced the GMC guidance unlawful in some respects and declared that it would be a breach of human rights to withhold or withdraw ANH from a competent patient who wanted it until his death was imminent and he was comatose. He also ruled that if a competent patient had expressed an informed wish for a particular treatment, it would be in the patient's best interests to receive that treatment.
Leslie Burke has lost his challenge against GMC guidance
Credit: MARK ST GEORGE/REX
But three appeal judges, headed by the master of the rolls, Lord Phillips, held that the GMC's guidance was lawful and said the case need never have been brought.
Mr Burke was already protected by the law, they said, and would have discovered this had he sought assurances from the GMC and the doctors caring for him.
Where a competent patient indicated a wish to be kept alive by ANH, "any doctor who deliberately brings that patient's life to an end by discontinuing the supply of ANH will not merely be in breach of duty but guilty of murder," said Lord Phillips.
A decision that the life of a competent patient who expressed the wish to remain alive should come to an end was not one that could lawfully be taken.
There was one exception: in the last stage of life ANH might not prolong life but might even hasten death. Whether to provide it was a clinical decision for the doctor, said Lord Phillips, sitting with Lord Justice Waller and Lord Justice Wall.
Ultimately, "a patient cannot demand that a doctor administer a treatment which the doctor considers is adverse to the patient's clinical needs."
In Mr Burke's case the evidence was that he would remain competent until the final stage of his disease. As long as ANH was prolonging his life he would be able to communicate his wishes with the aid of a computerised device.
In the final stages he would first lose the ability to communicate while remaining sentient and shortly afterwards lapse into a coma. During the final stages ANH would not be capable of prolonging his life.
Lord Phillips called for the GMC's guidance to be "vigorously promulgated, taught, understood, and implemented at every level and in every hospital."
The GMC's president, Graeme Catto, said: "Our guidance makes it clear that patients should never be discriminated against on the grounds of disability.
"And we have always said that causing patients to die from starvation and dehydration is absolutely unacceptable practice and unlawful."(Clare Dyer, legal correspondent)
The judgment, from Mr Justice Munby last July in the case of Leslie Burke, who has the degenerative disease spinocerebellar ataxia, was hailed as a landmark ruling for patients' rights.
Mr Burke had challenged the GMC's guidelines on withholding and withdrawing life prolonging treatments. He feared that when he reached the point where he could no longer communicate his wishes doctors would decide that his quality of life was too poor to continue artificial nutrition and hydration (ANH) and allow him to die of starvation and thirst.
Mr Justice Munby had pronounced the GMC guidance unlawful in some respects and declared that it would be a breach of human rights to withhold or withdraw ANH from a competent patient who wanted it until his death was imminent and he was comatose. He also ruled that if a competent patient had expressed an informed wish for a particular treatment, it would be in the patient's best interests to receive that treatment.
Leslie Burke has lost his challenge against GMC guidance
Credit: MARK ST GEORGE/REX
But three appeal judges, headed by the master of the rolls, Lord Phillips, held that the GMC's guidance was lawful and said the case need never have been brought.
Mr Burke was already protected by the law, they said, and would have discovered this had he sought assurances from the GMC and the doctors caring for him.
Where a competent patient indicated a wish to be kept alive by ANH, "any doctor who deliberately brings that patient's life to an end by discontinuing the supply of ANH will not merely be in breach of duty but guilty of murder," said Lord Phillips.
A decision that the life of a competent patient who expressed the wish to remain alive should come to an end was not one that could lawfully be taken.
There was one exception: in the last stage of life ANH might not prolong life but might even hasten death. Whether to provide it was a clinical decision for the doctor, said Lord Phillips, sitting with Lord Justice Waller and Lord Justice Wall.
Ultimately, "a patient cannot demand that a doctor administer a treatment which the doctor considers is adverse to the patient's clinical needs."
In Mr Burke's case the evidence was that he would remain competent until the final stage of his disease. As long as ANH was prolonging his life he would be able to communicate his wishes with the aid of a computerised device.
In the final stages he would first lose the ability to communicate while remaining sentient and shortly afterwards lapse into a coma. During the final stages ANH would not be capable of prolonging his life.
Lord Phillips called for the GMC's guidance to be "vigorously promulgated, taught, understood, and implemented at every level and in every hospital."
The GMC's president, Graeme Catto, said: "Our guidance makes it clear that patients should never be discriminated against on the grounds of disability.
"And we have always said that causing patients to die from starvation and dehydration is absolutely unacceptable practice and unlawful."(Clare Dyer, legal correspondent)