GMC guidance upheld

Abstract

A recent decision by the Court of Appeal in the case of Burke v General Medical Council[1] should be welcomed by anaesthetists and intensivists involved in the withholding and withdrawal of life-prolonging treatment. As previously discussed in this journal [2], the decision of the High Court was a significant departure from the English common law position, and would have theoretically allowed patients to determine future treatment that doctors may have otherwise agreed was not in their best interests. The Master of the Rolls, Lord Phillips of Worth Matravers, in giving the Court of Appeal's rather scathing judgement, dismissed Mr Burke's concerns that he would not be provided with artificial nutrition and hydration (ANH) unless death was imminent (at which point, ANH would serve no further purpose). More importantly, Lord Philips rejected the submission by the Official Solicitor that the claimant had performed a public service by enabling the legal, ethical and professional issues surrounding the withholding and withdrawal of life-prolonging treatments to be debated: ‘The danger is that the court will enunciate propositions of principle without full appreciation of the implications that these will have in practice, throwing into confusion those who feel obliged to attempt to apply those principles in practice. This danger is particularly acute where the issues raised involve ethical questions that any court should be reluctant to address, unless driven to do so by the need to resolve a practical problem that requires the court's intervention.' [1]. Effectively, Mr Justice Munby in the High Court had his knuckles rapped for exceeding his brief. Commentators will no doubt criticise the Court of Appeal's decision as a dereliction of their perceived duty as defenders of the public interest, and will complain that the medical profession remains the final arbiter of life or death decision making. The bottom line, however, is that the guidance contained in the General Medical Council's ‘Witholding and Withdrawing Life-prolonging Treatments: Good Practice in Decision Making’[3] remains valid, and does not contravene English common law or the Human Rights Act, 1998; it remains a valuable document for anaesthetists and intensivists. The GMC should be commended for pursuing the appeal.