On 19 May 2010, the General Medical Council (GMC) published its guidance on ‘living wills’ stating that medical practitioners could be struck off if they failed to respect the wishes of terminally ill patients who want to die by refusing treatment.
In response to recent legislation, including the Mental Capacity Act 2005, which gave so-called ‘living wills’ legal status, the GMC is specifying that doctors should allow the terminally ill the right to refuse food and water if they do not want treatment that will prolong their life. The GMC states that doctors must abide by ‘living wills’ where patients have indicated, in advance, that they do not wish to be resuscitated.
It addition the GMC stipulates that doctors should follow the wishes of patients, as communicated through a friend or relative, who has been designated their representative or ‘legal proxy’.
The GMC’s guidance makes clear that such directives can be ignored only where there is evidence that a patient may have changed his or her mind. The guidance also states that doctors should respect the wishes of patients who make their feelings clear verbally, provided they are deemed to have the mental capability of doing so.
It is clear from the guidance that doctors should not let their own personal or religious objections interfere with ‘living wills’.
It is specified in the guidance:
‘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.
‘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.’
(Click here to read the guidelines)
In October 2009, doctors at the Norfolk and Norwich University Hospital allowed a young woman to die because she requested no medical help if she attempted suicide and feared they would be charged with assault if they treated her. Kerrie Wooltorton, 26, was allowed to die because she had signed a ‘living will’ and doctors feared that that would mean they could be prosecuted if they intervened to save her life.
(See the CCFON report)
A doctors’ group and pro-life campaigners expressed their disappointment over the published guidance and suggested that it crossed all the lines.
Dr Peter Saunders, Chairman of Care Not Killing, an alliance of individuals and organisations bringing together disability and human rights organisations, healthcare and palliative care groups, and faith-based organisations, said many patients nearing the end of their lives could not articulate a change in their wishes. He said:
‘We must beware of the danger of allowing a hastily-drafted and ill-informed advance refusal to trump good clinical judgement.
‘Most people believe that there could be times when their best interests would be best served if clinicians ignored their directive. We trust therefore that the GMC will look kindly upon doctors who, for good clinical and ethical reasons and with the very best interests of the patient at heart, choose on occasions not to follow them.’
Dominica Roberts, the chairman of the Pro-Life Alliance, said:
‘Everybody has the right to refuse treatment. But feeding and hydrating a patient, even artificially, is not treatment, it is care.’
It is reported that the rules in the guidance also detail what doctors should do if a patient wants treatment to continue when there might not be any medical justification for it. The guidance states that if a patient requests a treatment — such as artificial feeding — to continue right up until the point of death, that their doctor can overrule such wishes if the doctor considers it would offer no benefit and cause the patient discomfort or harm.
In March 2009, the GMC’s draft guidance formally advised doctors for the first time that patients’ wishes – or those of their relatives – should be given greater weight in situations where there is a chance to prolong or save life, even for a short time.
(See the CCFON report)
In September 2009, a group of medical experts warned that official guidelines of the NHS used in UK hospitals were sentencing terminally ill patients to a premature death.
(See the CCFON report)
The new GMC guidelines come into force on 1 July 2010.