Letters

GMC guidance on withholding life prolonging treatment

BMJ 2003; 326 doi: http://dx.doi.org/10.1136/bmj.326.7400.1215-b (Published 29 May 2003) Cite this as: BMJ 2003;326:1215
  1. Hilary Thomas (jobrien{at}gmc-uk.org), chair, standards committee
  1. General Medical Council, London W1N 6JE

    EDITOR—Kmietowicz reports that advice on withholding food and water breaks the law.1 The GMC's guidance does not allow doctors to withdraw food and water from patients with the intent of causing or hastening their death (www.gmc-uk.org/standards). We believe such actions to be unlawful and unethical.

    The guidance covers the situation where—while a patient's death is not imminent—a doctor may judge that the patient's condition is so severe and the prognosis so poor that providing artificial nutrition or hydration may cause suffering or be too burdensome for the patient in relation to the possible benefits. A decision to withhold or withdraw artificial nutrition or hydration may be made in these cases only:

    • After a full assessment has been made of the patient's individual requirements and the possible means of providing nutrition and hydration—for example, by nasogastric tube, subcutaneous hydration, or intravenous cannula

    • After a full consultation with the healthcare team and those close to the patient

    • After a second opinion from a senior clinician who is not already directly involved in the patient's care has been sought (approval of a court is needed where the patient is in persistent vegetative state).

    The guidance was drafted after extensive consultation with medical, patient, human rights, religious, and other groups. We also sought advice from the official solicitor and other experts in medical law. We believe that the guidance is consistent with the law and takes into account recent judgments, including those relating to article 2 of the European Convention on Human Rights.

    Our guidance provides a framework to help doctors assess patients' individual needs and circumstances, and respond to them, making decisions in the best interests of patients.

    Footnotes

    • Competing interests None declared.

    References

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