GPs have been warned they will be judged to be causing harm and struck off the medical register if they ignore the wishes of dying or comatose patients who have made ‘living wills’ which say that their treatment should be withdrawn and their lives ended.
The draft of the new guidelines is to be circulated by the General Medical Council (GMC) advising doctors how to handle decisions about end-of-life care, including resuscitation and how they should deal with requests and refusals for life-prolonging treatment. The guidelines for all 150,000 practising doctors in Britain cover all life-threatening conditions or permanent disabilities, including heart failure, brain damage and cancer. If approved, they will come into force this year.
The new guidelines underline a shift in the debate on how critically ill patients are treated. Current legal precedents suggest that doctors, not patients, have the final say over whether to provide life-extending treatment or nutrition. At present they can refuse to do so if they judge it to be futile or not in the ‘best interests’ of the patient, because of possible pain or suffering.
For the first time the GMC guidance formally advises doctors that patients’ wishes – or those of their loved ones – should be given much greater weight in situations where there is a chance to prolong or save life, even for a short time.
Jane O’Brien, GMC assistant director on standards and ethics, said: ‘Clinicians still have the final say on “best interests”, but we are asking them to give greater weight to patients’ wishes in a more formal sense than we have before.’
‘Those who have strong feelings about how they want themselves or their loved ones to be treated should expect those feelings to be considered.’
(http://www.hc2d.co.uk/content.php?contentId=10516)
However, Ms O’Brien has not taken into account other important factors. Dr Peter Saunders, from Care Not Killing, said: ‘We have always been opposed to legally binding rules. A doctor who treats their patient can now be actively breaking the law’.
Nadine Dorries, Conservative MP, said: ‘It’s a thin line between someone wishing not to continue with treatment - and the state or others making that decision on someone’s behalf. All over the UK patients are being cared for safe in the knowledge that their life is protected in law. This ruling will make many vulnerable and elderly people very nervous indeed.’
Julian Brazier, another Conservative MP, is reported in the Daily Mail as saying, ‘Medical staff will frequently have crises of conscience when the law requires them to do something they know is wrong. The GMC guidelines reflect a pernicious law. ‘There is always a terrible risk with living wills that somebody has changed their mind and the doctors do not know. There is also a high risk that people have relatives with a vested interest in their death’.
The Times
http://www.timesonline.co.uk/tol/life_and_style/health/article5854702.ece
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BBC News
http://news.bbc.co.uk/1/hi/health/7929039.stm
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Christian Post
http://christianpost.com/Intl/General/2009/03/new-guidelines-for-living-wills-raise-concern-09/