Withholding and withdrawing life-prolonging treatments.

Abstract

AnaesthesiaVolume 57, Issue 12 p. 1216-1216 Free Access Withholding and withdrawing life-prolonging treatments First published: 18 November 2002 https://doi.org/10.1046/j.1365-2044.2002.02913_5.xAboutSectionsPDF ToolsRequest permissionExport citationAdd to favoritesTrack citation ShareShare Give accessShare full text accessShare full-text accessPlease review our Terms and Conditions of Use and check box below to share full-text version of article.I have read and accept the Wiley Online Library Terms and Conditions of UseShareable LinkUse the link below to share a full-text version of this article with your friends and colleagues. Learn more.Copy URL Share a linkShare onFacebookTwitterLinked InRedditWechat In response to both the decision in B v An NHS Trust (Miss B) [1] and continuing confusion amongst doctors and the public concerning end-of-life decisions, the General Medical Council (GMC) has recently published new guidelines, entitled Withholding and Withdrawing Life-prolonging Treatments: Good Practice in Decision-making[2]. The guidelines are thorough, and provide a useful ethical framework for doctors involved in such decisions (they will be of particular use to intensivists). Furthermore, the GMC has accurately interpreted recently decided, high-profile decisions in the cases of Miss B (competent patients may refuse life-saving treatment) and ReAK (validity of advanced refusals of treatment) [3], as well as reiterating the ratios of Airedale NHS Trust v Bland (legality of withdrawing futile treatment) [4]. Three points are of particular interest. Firstly, the GMC considers withdrawal of life-prolonging treatment to be morally equivalent to never starting the treatment in the first instance (paragraph 19), i.e. they do not recognise a distinction between the act of withdrawal and an initial treatment omission, stating that once a decision to withdraw treatment has been made in the patient's best interests, it can no longer be ethical to continue treating that patient; it is not withdrawal of treatment that causes death, so much as the underlying condition from which the patient is suffering (this is one of the decisions of the Miss B case). Second, the GMC recognises that a doctor (of any grade) may have a conscientious objection to discontinuing treatment. In this instance, however, the doctor concerned still has a duty to arrange for the patient's care to be taken over by another suitably qualified doctor (paragraphs 28 and 29). Third, doctors may not make discriminatory decisions about life-prolonging therapy – the elderly are as entitled to life-prolonging care as the young. However, the GMC has stopped short of explicitly stating that decisions should not take into account financial constraints –‘Doctors have a duty to give priority to patients on the basis of clinical need, while seeking to make the best use of resources …’ (paragraph 25). The GMC is to be commended on the speed with which they have responded to professional and lay concerns by producing these guidelines. S. M. White Guy's and St.Thomas' Hospital Trust, London SE1 9RT, UK References 1 Anon. B v An NHS Trust 2002 EWHC 429 (Fam). http://www. courtservice.gov.uk/judgementsfiles/j1075/B_v_NHS.htm. Google Scholar 2 GMC. Withholding and Withdrawing Life-prolonging Treatments: Good Practice in Decision-making. The London: General Medical Council, August 2002. http://www.gmc-uk.org/ . Google Scholar 3 Anon. ReAK (Adult patient) (Medical treatment: consent) 2001 1 FLR 129. Google Scholar 4 Anon. Airedale NHS Trust v Bland 1993 1 All ER 821 (HL). Google Scholar Volume57, Issue12December 2002Pages 1216-1216 ReferencesRelatedInformation