British doctors' oversight group challenges disabled man's right to choose artifical hydration

The right of the disabled to choose to continue to receive food and water is being contested in court in the United Kingdom.

The Daily Telegraph reports that the General Medical Council (GMC) is appealing a 2004 British High Court decision that gave a terminally ill Lancaster man the right to insist on receiving food and water through a tube, regardless of the opinion of his doctors.

Last summer, the High Court ruled in favor of Leslie Burke, who was diagnosed over 20 years ago with a degenerative neurological condition that will eventually cause him to lose the ability to swallow, while still retaining full awareness. Burke does not want to die of thirst, a process that can take two to three weeks. Because he may also lose the ability to speak by that time, he wants to ensure that his wishes are followed while he can still express them. Burke went to the court to challenge GMC guidelines that would let the doctors, not him, decide whether he should have a feeding tube:

GMC guidelines published in 2002 tell doctors it is their responsibility, rather than that of the patient, to decide whether to withhold or withdraw life-prolonging treatment.

Paragraph 81 effectively allows doctors to withdraw artificial nutrition or hydration from a patient who is not dying because it "may cause suffering, or be too burdensome in relation to the possible benefits".

At the time, the GMC said that the court ruling was unnecessary, that nothing in its standards would require or encourage a doctor to withhold food and water. Now the GMC has filed an appeal, arguing that the ruling gives a patient too much power:

Yesterday, Philip Havers, QC, for the doctors' governing body, said the judge's ruling had effectively "extended the reach of patient autonomy" and redefined the test as to what treatment was in a patient's best interests.

Mr Havers said there was "no evidence" that any member of the medical profession was likely to treat Mr Burke, or apply the GMC's guidance, in the way that he feared.

Follow that? The GMC is saying we're pretty sure we'll give you food and water, but we don't want the law to require us to do it if we don't want to.

In written submissions, however, Mr Havers told the Master of the Rolls, Lord Phillips, sitting with Lords Justices Waller and Wall, that Mr Justice Munby's conclusions put doctors in an "impossibly difficult position".

The result would be that a patient could require a doctor to provide a form of treatment that the doctor considered of no clinical benefit if not harmful.

"Such a conclusion is not in the best interests of patients," said Mr Havers - both as a matter of principle and because it would gravely undermine the "therapeutic partnership based on joint decision-making between doctors and patients".

It would also put the doctor "in an impossibly difficult position, for a doctor should never be required to provide a particular form of treatment to a patient which he does not consider to be clinically appropriate".

Requiring doctors to provide such treatment would undermine the relationship of trust that doctors have with the public they seek to serve, Mr Havers added. It would also be inconsistent with the Hippocratic oath that doctors used to take.

Notice that the GMC is classifying food and water as "treatment," not as basic necessities of life. Notice, too, the gobbledygook about how giving a patient the right not to die of thirst would undermine the "therapeutic partnership" and the "relationship of trust" between patient and doctor.

I think Leslie Burke would not care much about the state of his "therapeutic partnership" with a doctor who is trying to starve him to death.

Read what Burke had to say after last summer's court ruling:

Mr Burke said it seemed as if a great weight had been lifted from his shoulders. "I am ecstatic," he said. "I can't tell you what it means to me.

"Anybody could be in the same situation so this has far-reaching consequences. It could happen to somebody in a car accident, not just people with a disability.

"A doctor could decide to withdraw hydration and nutrition and effectively starve a person until they die.

"Doctors have told me I'm going to deteriorate to the stage where I need to be hospitalised and need artificial nutrition and hydration. This could be in 15 or 20 years, but my communication and speech is already deteriorating and is a problem now.

"I won't be able to communicate my wishes either way and this could just be withdrawn without my consent. I would be fully conscious the whole time and it could take two or three weeks to die.

"It's not any way to treat vulnerable people. In a civilised society, it can't be right to allow vulnerable people to effectively starve to death."

Hear, hear. Let's pray that the appeals court agrees.