The aim of this guideline is to inform health and social care professionals on how best to manage advance care planning (ACP) in clinical practice. At the core of current health and social care are efforts to maximise individuals’ autonomy, promote patient-centred care, offer choice and the right to decide one’s own treatment or care. This can be difficult to achieve when an individual has lost capacity – the ability to make their own, informed decision. ACP is one method of enhancing autonomy, not only where an individual has lost capacity, but also by focussing discussion on the individual’s values and preferences throughout the time they are in contact with health or social care professionals. Whilst ACP has been used for some time in North America, there has been relatively little experience in the use of ACP in the UK. This set of concise evidence-based guidelines has therefore been prepared to guide practitioners.
Aims: This guidance relating to the management of the birth of extremely preterm babies (at less than 26 weeks of gestation) is aimed at both parents and healthcare professionals. It addresses communication before delivery, management recommendations, neonatal resuscitation and ethical considerations. Intended audience: Obstetricians, healthcare professionals working in maternity settings, parents of preterm babies. Publication history information: Published online 06 October 2008.
The British Medical Association and the General Medical Council have already made it abundantly clear that they want no part in voluntary euthanasia becoming a clinical practice. Now the estimable Royal College of Physicians, the professional body representing over 20,000 physicians that “aims to improve the quality of patient care by continually raising medical standards”, has weighed in with a strongly worded letter to the DPP. “We would go so far as to say”, writes the College’s Registrar, Dr Rodney Burnham, “that any clinician who has been part, in any way, of assisting a suicide death should be subject to prosecution.” Dr Burnham continues: “The trust afforded doctors and nurses in particular gives their views considerable weight with their patients and the public. Clinicians’ duties of care entail active pursuit of alternative solutions to assisted suicide, not its facilitation.”
A leading doctors’ organisation has today warned that doctors face a greater risk of prosecution for assisting a patient’s suicide following the publication of the DPP’s final Policy for Prosecutors in Respect of Cases of Encouraging or Assisting Suicide. The Medical Protection Society (MPS) – which provides indemnity, legal and professional support to around half of all doctors in the UK – said that the new policy sends a clear signal that prosecutions are more likely to be brought against healthcare professionals in circumstances where they might have assisted a patient’s suicide. The organisation warned doctors to be extremely cautious when providing help or advice to patients who are considering assisted suicide.
The MDU has grave concerns about how the new policy* on whether or not to prosecute the offence of assisted suicide, will be applied to doctors. “The MDU’s advice to its members remains that doctors approached by patients for advice about suicide should not engage in discussion which assists the patient to that end. Members who are faced with requests for help from patients, including for example the provision of medical reports, should contact us for advice.”
The BMA has long advised doctors - for moral as well as legal reasons - to avoid actions that might be interpreted as assisting, facilitating or encouraging a suicide attempt. This means not giving patients advice on what constitutes a fatal dose or on anti-emetics in relation to a planned overdose, not suggesting the option of suicide abroad nor writing medical reports specifically to facilitate assisted dying abroad, nor on any other aspects of planning a suicide.
The Society for Old Age Rational Suicide was established in Brighton and Hove, by several right-to-die activists and humanists, in 2009. Presently, the main objective of SOARS is to begin a campaign to get the law eventually changed in the UK so that very elderly, mentally competent individuals, who are suffering unbearably from various health problems (although none of them is “terminal”) are allowed to receive a doctor’s assistance to die, if this is their persistent choice. Surely the decision to decide, at an advanced age, that enough is enough and, avoiding further suffering, to have a dignified death is the ultimate human right for a very elderly person. Although there is much public support for this to become lawful in the UK, it is unlikely that Parliament (either at Westminster or in Edinburgh) will change the law, to help those who are terminally ill, for at least five to ten years.
A public policy think tank, which aims to promote “rational, evidence-based and measured debate” on the subject of assisted dying, has been launched by two members of the House of Lords. Lord Alex Carlile and Baroness Ilora Finlay, co-chairs of Living and Dying Well, have both fervently opposed any change in the law on this issue. Their new organisation is neither “neutral” nor “a campaigning pressure group,” instead, they want to present “hard evidence” to parliament and the public in an objective and informative manner.
This End of life guidance covers three main issues: contemporaneous and advance refusal of treatment; withholding and withdrawing life-prolonging medical treatment; assisted dying - euthanasia and assisted suicide.
UK doctors have set up a new group for health professionals to challenge the BMA and a number of royal colleges in their stance against assisted dying for terminally ill people and to push for a change in the law. The group, called Dignity in Dying: Healthcare Professionals for Change, was set up by Ann McPherson, who is dying of pancreatic cancer, after an article she wrote in the BMJ last year generated interest in giving people who are dying the option of help to end their lives when they chose (BMJ 2009;339:b2827 doi:10.1136/bmj.b2827). Dr McPherson, who is a fellow of the Royal College of General Practitioners, said she wants the royal colleges to have a more informed debate about assisted suicide.
The Monday Interview: A growing number of medical professionals are supporting the idea of assisted dying. Dr Ann McPherson – who herself has only months to live – tells Jeremy Laurance why
“The current legal status of assisted dying is inadequate and incoherent...” The Commission on Assisted Dying was set up in September 2010 to consider whether the current legal and policy approach to assisted dying in England and Wales is fit for purpose. In addition to evaluating the strengths and weaknesses of the legal status quo, the Commission also set out to explore the question of what a framework for assisted dying might look like, if such a system were to be implemented in the UK, and what approach to assisted dying might be most acceptable to health and social care professionals and to the general public.