GMC appeals against judgment on withholding treatment
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《英国医生杂志》
The General Medical Council filed an appeal last week against a high court ruling which has cast doubt on key aspects of the GMC抯 guidance on the circumstances in which doctors can properly withhold or withdraw treatment which prolongs life.
The ruling was won last July by Leslie Burke, aged 44 (BMJ 2004;329:309, 7 Aug). He has cerebellar ataxia and told the court that he feared that doctors might withdraw artificial feeding and let him die if he lost the ability to communicate.
Ruling in his favour, Mr Justice Munby said the legal content of the guidance, issued in 2002, was "properly vulnerable" to criticism in some respects. It failed to acknowledge the duty of a doctor who was unable or unwilling to carry out the wishes of his patient to go on providing treatment until he could find another doctor who would do so.
It also failed to acknowledge the heavy presumption in favour of life prolonging treatment, or to spell out the legal requirement in certain circumstances to get prior judicial sanction for the withdrawal of artificial nutrition and hydration.
The GMC said, "We welcomed much of the judgment, but we are concerned that some key issues are unclear. The GMC has a duty to provide doctors with clear guidance to assist with their decision making.
"This is an area where the law is complex and continues to evolve, especially in the light of the European Convention on Human Rights. The courts are the right place to reach a clear understanding of the legal framework from which we can develop helpful professional guidance.
"The issues raised in the case are of fundamental importance to everyone in society. In granting leave to appeal, Mr Justice Munby himself suggested a compelling public interest in favour of taking these matters to the appeal court."
The BMA, which believes that the high court judgment left unclear hospitals?obligations to continue providing active treatment when mentally incapacitated people have left no summary of their wishes, supported the decision to appeal.
Michael Wilks, the BMA抯 chairman of ethics, said, "It is absolutely essential for all involved that the law and professional guidance is clear. Although in this case, Mr Burke was worried about his active treatment being stopped before he would have wanted, many patients worry about the risks of being kept alive by medical technology beyond the point where they would have chosen non-invasive palliative care.
"We hope that the GMC appeal will clarify ambiguities in the judgment without losing many of the helpful points in it about listening to patients?views."(BMJ Clare Dyer legal corr)
The ruling was won last July by Leslie Burke, aged 44 (BMJ 2004;329:309, 7 Aug). He has cerebellar ataxia and told the court that he feared that doctors might withdraw artificial feeding and let him die if he lost the ability to communicate.
Ruling in his favour, Mr Justice Munby said the legal content of the guidance, issued in 2002, was "properly vulnerable" to criticism in some respects. It failed to acknowledge the duty of a doctor who was unable or unwilling to carry out the wishes of his patient to go on providing treatment until he could find another doctor who would do so.
It also failed to acknowledge the heavy presumption in favour of life prolonging treatment, or to spell out the legal requirement in certain circumstances to get prior judicial sanction for the withdrawal of artificial nutrition and hydration.
The GMC said, "We welcomed much of the judgment, but we are concerned that some key issues are unclear. The GMC has a duty to provide doctors with clear guidance to assist with their decision making.
"This is an area where the law is complex and continues to evolve, especially in the light of the European Convention on Human Rights. The courts are the right place to reach a clear understanding of the legal framework from which we can develop helpful professional guidance.
"The issues raised in the case are of fundamental importance to everyone in society. In granting leave to appeal, Mr Justice Munby himself suggested a compelling public interest in favour of taking these matters to the appeal court."
The BMA, which believes that the high court judgment left unclear hospitals?obligations to continue providing active treatment when mentally incapacitated people have left no summary of their wishes, supported the decision to appeal.
Michael Wilks, the BMA抯 chairman of ethics, said, "It is absolutely essential for all involved that the law and professional guidance is clear. Although in this case, Mr Burke was worried about his active treatment being stopped before he would have wanted, many patients worry about the risks of being kept alive by medical technology beyond the point where they would have chosen non-invasive palliative care.
"We hope that the GMC appeal will clarify ambiguities in the judgment without losing many of the helpful points in it about listening to patients?views."(BMJ Clare Dyer legal corr)