BMA calls for extra safeguards for life and death decisionsBMJ 1999; 318 doi: https://doi.org/10.1136/bmj.318.7200.1716c (Published 26 June 1999) Cite this as: BMJ 1999;318:1716
Decisions to withhold or withdraw life prolonging treatment can often be taken without referral to the law courts, but there is a need for extra safeguards, according to a BMA report.
At present, proposals to withdraw artificial nutrition and hydration from patients in a persistent vegetative state require legal review in all countries of the United Kingdom except Scotland, but the courts have not specified what should happen to patients with other serious conditions, such as advanced dementia or a very severe stroke. “This arguably leaves doctors in an area of legal uncertainty and therefore open to challenge,” the report warned. “Particular care needs to be taken when making such decisions and the BMA believes that additional safeguards should be followed.”
The report recommends that all proposals to withhold or withdraw artificial nutrition and hydration should be subject to formal clinical review by a senior clinician who is not part of the treating team. In addition, all cases in which artificial nutrition and hydration have been withdrawn should be available for clinical review to ensure that appropriate procedures and guidelines were followed. Anonymised information should be available on request.
The BMA starts from the premise that if medical treatment does not provide a net benefit to the patient it may, ethically and legally, be withheld or withdrawn. Treatment should never be withheld when there is a possibility that it will benefit the patient simply because withholding it is considered easier than withdrawing treatment. If there is reasonable doubt about benefit, treatment should be provided for a trial period. Decisions to withhold or withdraw treatment should be made by the clinician in charge after discussion with the health team and people close to the patient. If the clinician's view is seriously challenged, review by a court is advisable. (See p 1709.)
Withholding or Withdrawing Life-prolonging Medical Treatment—Guidance for Decision Making is published by BMJ Books and is available from BMJ Bookshop (0171 383 6455).