The General Medical Council are to announce that Doctors who ignore the wishes of terminally ill patients who refuse treatment can be struck off.
It is stated that Doctors could be guilty of negligence if they fail to abide by ‘living wills’, this is where the patient can ask not to be resuscitated and also that the terminally ill must be allowed to refuse food and water or treatment that could prolong their life.
Also the GMC has stated that if the terminally ill person has designated a ‘legal proxy’ who is a relative or friend who can speak on their behalf, doctors must follow their direction.
Some pro-life campaigners and a doctors group said that they felt uneasy about this direction and thought the newly published guidance had gone too far.
This new guidance responds to some new laws including the Mental Capacity Act 2005. This new act gave legal status to ‘living wills’. There have since been controversial cases like Kerrie Wooltorton, age 26, who ordered doctors not to treat and save her after she had poisoned herself using a ‘living will’.
This new guidance clarifies that patients wishes may only be ignored when there is evidence to show that a change of mind may have taken place. Under this directive, if patients express their wishes verbally, those wishes must be followed provided they are mentally able to make sound judgement.
It is stated that a second medical opinion must be sought before hydration and nutrition is stopped, and also that although a doctor can withdraw from treating an individual patient on these grounds they must not let their own personal or religious beliefs affect their actions.
The guidance states: “Following established ethical and legal (including human rights) principles, decisions covering potentially life-prolonging treatments must not be motivated by a desire to bring about a patient’s death and must start with a presumption in favour of prolonging life. This presumption will normally require you to take all reasonable steps to prolong a patient’s life”
It is also stated that “However, there is no absolute obligation to prolong life irrespective of the consequences for the patient, and irrespective of the patient’s views, if they are known or can be found out.”
If a doctor fails to follow the guidelines, they will be brought before the GMC in a hearing. If it is proved at the hearing that they have gone against the guidelines then the Doctor would be struck off. Only patients who are mentally capable of making such decisions are affected by the guidelines. In cases concerning end of life treatment where the individual is no longer able to make their feelings known, the doctor must follow any wishes that were previously made known.
From the Christian Medical Fellowship, Dr Peter Saunders addresses the difficulty for those nearing the end of life to communicate a change of mind, and in these cases he believes that ‘hastily-drafted and ill informed’ refusals should not have to be considered before good clinical judgement.
This directive also addresses the other end of the spectrum, where it may be the patients wish to continue treatment that is either not beneficial or unnecessary. Here the doctor is allowed to overrule the patient’s wishes if it is believed that the treatment (like artificial feeding) would cause them discomfort or harm.
Dr Tony Calland, of the British Medical Association, which was involved in developing the guidance, said: “We believe the GMC’s guidance is clear about the need to work with the patient to ensure that they are treated fairly, with dignity and without prejudice.”
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