GMC challenges court ruling on end of life decisions
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《英国医生杂志》
The General Medical Council went to the Court of Appeal in London this week to try to overturn a landmark high court ruling. The ruling had declared that parts of the council's guidance to doctors on withholding and withdrawing life prolonging treatment were unlawful.
Leslie Burke fears that when he loses the power to communicate, doctors might decide not to provide artificial nutrition
Credit: ANDREW PARSONS/PA/EMPICS
Last July, Leslie Burke, who is 45 years old and has cerebral ataxia, won the ruling, which was hailed as a breakthrough for the rights of vulnerable patients ( BMJ 2004;329: 309). Mr Burke, who is in a wheelchair, went to court because he feared that when he loses the power to swallow and to communicate, doctors might decide not to provide artificial nutrition and hydration, leaving him to die of thirst and starvation.
Mr Justice Munby, who delivered the high court judgment, ruled that the GMC's guidance placed too much emphasis on the right of a patient to refuse treatment and not enough on the patient's right to require treatment. He said it should be for patients not doctors to decide what was in their best interests and that there should be a presumption in favour of prolonging life.
If patients were unable to make their own decisions, the touchstone for deciding whether it was in their best interests to withdraw treatment was whether the life which would be prolonged was "intolerable."
The guidance, the judge said, was also deficient because it failed to spell out that if a patient wanted artificial feeding but the doctor was against it, the doctor had a duty to look for another doctor who was willing to carry it out and to continue treating the patient until that doctor took over. It also did not make clear that doubtful or disputed cases should be referred to the courts.
Philip Havers QC, for the GMC, told three appeal court judges, headed by the master of the rolls, Lord Phillips, that Mr Justice Munby's judgment, if upheld, could put doctors in "an impossibly difficult position."
It meant that "the doctor must provide the treatment which the patient demands notwithstanding that the doctor's clear professional view is that the treatment will provide the patient with no clinical benefit or will be futile."
He added that a doctor should never have to give a patient a particular form of treatment that he or she does not consider clinically appropriate.
Mr Havers said that Mr Justice Munby had "set the bar too high" in saying that artificial nutrition and hydration should be provided unless the patient's life would be intolerable. The correct test was whether the treatment was in the patient's best interests.(Clare Dyer, legal correspondent)
Leslie Burke fears that when he loses the power to communicate, doctors might decide not to provide artificial nutrition
Credit: ANDREW PARSONS/PA/EMPICS
Last July, Leslie Burke, who is 45 years old and has cerebral ataxia, won the ruling, which was hailed as a breakthrough for the rights of vulnerable patients ( BMJ 2004;329: 309). Mr Burke, who is in a wheelchair, went to court because he feared that when he loses the power to swallow and to communicate, doctors might decide not to provide artificial nutrition and hydration, leaving him to die of thirst and starvation.
Mr Justice Munby, who delivered the high court judgment, ruled that the GMC's guidance placed too much emphasis on the right of a patient to refuse treatment and not enough on the patient's right to require treatment. He said it should be for patients not doctors to decide what was in their best interests and that there should be a presumption in favour of prolonging life.
If patients were unable to make their own decisions, the touchstone for deciding whether it was in their best interests to withdraw treatment was whether the life which would be prolonged was "intolerable."
The guidance, the judge said, was also deficient because it failed to spell out that if a patient wanted artificial feeding but the doctor was against it, the doctor had a duty to look for another doctor who was willing to carry it out and to continue treating the patient until that doctor took over. It also did not make clear that doubtful or disputed cases should be referred to the courts.
Philip Havers QC, for the GMC, told three appeal court judges, headed by the master of the rolls, Lord Phillips, that Mr Justice Munby's judgment, if upheld, could put doctors in "an impossibly difficult position."
It meant that "the doctor must provide the treatment which the patient demands notwithstanding that the doctor's clear professional view is that the treatment will provide the patient with no clinical benefit or will be futile."
He added that a doctor should never have to give a patient a particular form of treatment that he or she does not consider clinically appropriate.
Mr Havers said that Mr Justice Munby had "set the bar too high" in saying that artificial nutrition and hydration should be provided unless the patient's life would be intolerable. The correct test was whether the treatment was in the patient's best interests.(Clare Dyer, legal correspondent)