End of life decisions

BMJ 2005; 331 doi: https://doi.org/10.1136/bmj.331.7528.1284 (Published 01 December 2005) Cite this as: BMJ 2005;331:1284
  1. Ash Samanta (ash.samanta@uhl-tr.nhs.uk), consultant rheumatologist,
  2. Jo Samanta, lecturer in law
  1. Leicester Royal Infirmary, Leicester LE1 5WW
  2. De Montfort University, Leicester LE1 9BH

    Clinical decisions are increasingly shaped by legal judgments

    In July this year the court of appeal allowed the appeal of the General Medical Council (GMC) in the case of R (Burke) v the GMC,1 setting aside the high court declaration that the GMC guidance on withholding and withdrawing life prolonging treatment was unlawful and in breach of human rights.2 This welcome judgment represents a much needed endorsement of clinical discretion and judgment.

    Mr Burke, tragically, has a progressive degenerative neurological condition and will eventually require artificial nutrition and hydration. He fears that on losing the ability to communicate doctors might decide that his quality of life is such that they should withdraw artificial nutrition and hydration, considering this to be futile treatment, and that this would cause him acute mental and physical suffering in contravention of his human rights. He sought judicial review of the GMC guidance on the withdrawal of artificial nutrition and hydration.3

    The high court judge ruled that an advance directive to require artificial nutrition and hydration would be valid, and that a number of paragraphs in the GMC guidance were unlawful as there was insufficient emphasis on the patient's rights to require, rather than refuse, treatment. He also held that in determining the …

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