The book strives for as complete and dispassionate a description of the situation as possible and covers in detail: the substantive law applicable to euthanasia, physician-assisted suicide, withholding and withdrawing treatment, use of pain relief in potentially lethal doses, terminal sedation, and termination of life without a request (in particular in the case of newborn babies); the process of legal development that has led to the current state of the law; the system of legal control and its operation in practice; and, the results of empirical research concerning actual medical practice.
A joint statement from the British Medical Association, the Resuscitation Council (UK) and the Royal College of Nursing Health professionals are aware that decisions about attempting cardiopulmonary resuscitation (CPR) raise very sensitive and potentially distressing issues for patients and people emotionally close to them. Some health professionals do not find it easy to discuss CPR with their patients, but this must not prevent discussion, either to inform patients of a decision or involve patients in the decision-making process, where appropriate. These guidelines identify the key ethical and legal issues that should inform all CPR decisions. These basic principles are the same for all patients, in all settings, but differences in clinical and personal circumstances make it essential that all CPR decisions are made on an individual basis. The guidelines provide a framework to support decisions relating to CPR and communicating them effectively.
Sky Television’s documentary showing an assisted suicide has provoked a storm in UK tabloids, but the medical ethicist Daniel K Sokol says it has reinforced his belief in the moral permissibility of helping people die in exceptional circumstances.
Comprehensive guidance for doctors on care at the end of life, including difficult decisions on when to provide, withhold, or withdraw life prolonging treatment, will go out for consultation from the UK’s General Medical Council in March. The draft guidance was approved by the council at its February meeting, subject to minor amendments. The consultation will be launched in the week beginning 23 March and will end in July. The new advice takes account of the Mental Capacity Act 2005; government strategies on end of life care in England and Scotland; GMC guidance in 2007 on consent; recent research; and a Court of Appeal judgment on a legal challenge to the GMC’s 2002 guidance Withholding and Withdrawing Life-Prolonging Treatments (Burke).
There is evidence from outside the UK to show that physicians’ religious beliefs influence their decision making at the end of life. This UK study explores the belief system of consultants, nurse key workers & specialist registrars & their attitudes to decisions which commonly must be taken when caring for individuals who are dying. Results showed that consultants’ religion & belief systems differed from those of nurses & the population they served. Consultants & nurses had statistically significant differences in their attitudes to common end of life decisions with consultants more likely to continue hydration & not withdraw treatment. Nurses were more sympathetic to the idea of PAS for unbearable suffering. This study shows the variability in belief system and attitudes to end of life decision making both within and between clinical groups. The personal belief system of consultants was not shown to affect their overall attitudes to withdrawing life-sustaining treatment or PAS.
Parents battling to keep their seriously ill baby alive have failed to overturn a ruling allowing him to die. The nine-month-old boy has a rare metabolic disorder and has suffered brain damage and respiratory failure. The couple had appealed against a judge's ruling on Thursday that it was in the boy's best interests to withdraw his "life sustaining treatment". The High Court ruling gives doctors at an unnamed NHS trust powers to turn off the ventilator keeping "baby OT" alive.
The GMC is consulting on new draft guidance, End of life treatment and care: Good practice in decision-making. The new guidance updates and builds on our existing publication Withholding and withdrawing life-prolonging treatments (2002) which clarified what we regarded as acceptable practice in this difficult area of end of life care. Since it was published, there have been significant changes in legislation, case law, public policy and the understanding of the effects of treatments, all of which affect the framework within which end of life care is provided. The GMC has also produced new guidance on Consent: patients and doctors making decisions together (2008) which sets out the broad principles of good decision-making which apply across the range of situations that doctors face, including end of life care. It was agreed that the Withholding and withdrawing guidance should be reviewed and updated to take account of these developments.
Twenty-five years ago it was common practice to bring about the deaths of some children with learning disabilities or physical impairments. This paper considers a small number of landmark cases in the early 1980s that confronted this practice. These cases illustrate a process by which external forces (social, philosophical, political, and professional) moved through the legal system to effect a profound change outside that system – primarily in the (then) largely closed domain of medical conduct/practice. These cases are considered from a socio-legal perspective. In particular, the paper analyses the reasons why they surfaced at that time, the social and political contexts that shaped the judgments, and their legacy.
Aims: These guidance notes have been produced to help healthcare workers and organisations to achieve uniformly high standards in making DNAR decisions and in ensuring that all relevant aspects of these decisions are recorded and communicated to others effectively. They are not intended to be a comprehensive guide to decisions about cardiopulmonary resuscitation. Intended audience: Healthcare professionals. Publication history information: Published May 2009. Access: Available to the general public.
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.
A national survey of 3733 UK doctors reporting on the care of 2923 people who had died under their care is reported here. Results show that there was no time to make an ‘end-of-life decision’ (deciding to provide, withdraw or withhold treatment) for 8.5% of those reporting deaths. A further 55.2% reported decisions which they estimated would not hasten death and 28.9% reported decisions they had expected to hasten death. A further 7.4% reported deaths where they had to some degree intended to hasten death. Where patients or someone else had made a request for a hastened death, doctors were more likely to report expecting or at least partly intending to hasten death. Doctors usually made these decisions in consultation with colleagues, relatives and, where feasible, with patients.
Around a third of doctors say they have given drugs to terminally ill patients or withdrawn treatment, knowing or intending that it would shorten their life. A study of doctors in charge of the last hours of almost 3,000 people finds decisions almost always have to be made on whether to give drugs to relieve pain that could shorten life and whether to continue resuscitation and artificial feeding. In 211 cases (7.4%), doctors say they gave drugs or stopped treatment to speed the patient's death. In 825 cases (28.9%), doctors made a decision on treatment that they knew would probably or certainly hasten death. One in 10 patients asked their doctor to help them die faster. What doctors do varies according to their religious beliefs, according to Prof Clive Seale, who carried out the research. But, he said, there was no evidence of a "slippery slope": that deaths of the most vulnerable, such as very elderly women and those with dementia, are being hastened more than others.
A father is fighting a hospital's attempt to withdraw support keeping his baby son alive. The one-year-old, known as Baby RB for legal reasons, was born with a rare, genetic muscle condition that makes it hard for him to breathe independently. His parents are going to the High Court - the mother is reportedly supporting the hospital's bid. The father's lawyers argue that the boy's brain is unaffected, meaning he can see, hear, interact and play. Despite having to remain in hospital and being dependent on a ventilator to breathe, he enjoys having stories read to him and listening to music, they say. The lawyers are submitting video footage to the court, which they say shows him playing with his toys. But the hospital says that Baby RB's quality of life is so low that it would not be in his best interests to try to save him. Baby RB was born with congenital myasthenic syndrome and has been in hospital since birth.
A father whose son was born with a rare neuromuscular condition will go to the high court tomorrow in an attempt to stop a hospital withdrawing the support that keeps the child alive. Doctors treating the one-year-old say the boy's quality of life is so poor that it would not be in his best interests to save him. They are reportedly being supported in their action by the baby's mother, who is separated from his father. The child, known for legal reasons as Baby RB, was born with congenital myasthenic syndrome (CMS), a muscle condition that severely limits movement and the ability to breathe independently. He has been in hospital since birth. If the hospital succeeds in its application, it will be the first time a British court has gone against the wishes of a parent and ruled that life support can be discontinued or withdrawn from a child who does not have brain damage.
A one-year-old boy at the centre of a "right-to-life" legal dispute would not benefit from an operation to help him breathe, the High Court has been told. The child, known as Baby RB, has a rare, genetic condition that makes it hard for him to breathe independently. But a leading paediatrician, known as Dr F, said he was "not a candidate" for surgery to try to open up his airway. Baby RB's father is fighting a hospital's attempt - backed by the mother - to withdraw his life support.
A doctor has agreed a baby in a "right-to-life" legal row may be able to interact - but any mental development would only make his fate more tragic. The paediatric neurologist told the High Court the severely disabled child, Baby RB, would remain in a "no chance" situation even if he developed further. He questioned the life the boy would lead if he was capable of cognitive function but physically so disabled.
A doctor has said that a baby in a "right-to-life" legal row has the potential to communicate and even operate a wheelchair in years to come. The paediatric neurologist, Professor Fenella Kirkham, told the High Court that Baby RB had the normal intelligence of a one-year-old. She said he was likely to develop language recognition skills and he may be better off at home. The boy's father is fighting an attempt by the hospital to end life support.
A father who had been fighting to stop a hospital withdrawing life support from his seriously ill son has dropped his objections. The one-year-old, known as Baby RB for legal reasons, was born with a rare, genetic muscle condition that makes it hard for him to breathe independently. The hospital was backed by the baby's mother. But the move had been strongly opposed by the child's father at a High Court hearing. However, the father changed his mind after hearing medical evidence which suggested it would be in the best interests of the child if medical support was withdrawn. Lawyers for the health authority caring for the baby in intensive care told Mr Justice McFarlane: "All of the parties in court now agree that it would be in RB's best interests for the course suggested by the doctors to be followed."
A father who went to the High Court to try to stop a hospital turning off his seriously ill baby son's life support machine has dropped his objections to the move. The outcome has prompted a mixture of sadness and relief. For six days they had sat in the bland surroundings of Court 50 at London's High Court listening to others talking about their baby son's quality of life. A host of paediatricians, nurses, and experts went into the witness box. Many of them urged a judge to decide that this profoundly disabled 13-month-old boy should be allowed to die. It was, they said, no longer in his best interests to keep him alive.
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.
The aim in this paper is to challenge the increasingly common view in the literature that the law on end-of life decision making is in disarray and is in need of urgent reform. The argument is that this assessment of the law is based on assumptions about the relationship between the identity of the defendant and their conduct, and about the nature of causation, which, on examination, prove to be indefensible. A clarification of the relationship between causation and omissions is provided which proves that the current legal position does not need modification, at least on the grounds that are commonly advanced for the converse view. This paves the way for a clarification, in conclusion, of important conceptual and moral differences between withholding, refusing and withdrawing life-sustaining measures, on the one hand, and assisted suicide and euthanasia, on the other.
The order by Mr Justice Baker was issued in a case involving a woman, who can be referred to only as "M". She has been in "a minimally conscious state" since suffering from swelling of the brain stem, which caused serious damage and wasting to the brain. The woman suffered the illness in 2003, when she was 43, and has been minimally conscious since then.
A mother is seeking a court's permission to withdraw life-sustaining artificial nutrition and hydration from her brain-damaged daughter. The woman, 53, who can only be referred to as "M" for legal reasons, is in a "minimally conscious state".
A 46-year-old-man who wants to die after a stroke that left him almost completely paralysed is bringing a groundbreaking legal action that could effectively lead to the legalisation of assisted suicide in the UK. Martin was a fit and active man who enjoyed rugby, cars and socialising with friends in the pub before suffering a brainstem stroke three years ago. Now requiring round-the-clock care, his mobility is limited to moving his eyes and small movements of his head. He communicates by staring at letters on a computer screen which the machine recognises and forms into words spoken by a digitised voice. Martin has been asking to die since six months after the stroke but says he has no one willing to assist him and cannot on his own organise a trip to the Swiss clinic Dignitas, where he could end his life legally. His wife, who chooses to be known as Felicity, says she will be with him if he dies but will not help bring about his death.
The husband of a woman who died in one of Britain's best-known hospitals is taking its management and the health secretary Andrew Lansley to court, alleging an illegal use of "do not resuscitate" orders. David Tracey claims doctors at Addenbrooke's hospital, Cambridge, twice put such orders in his wife's medical notes, cancelling the first after she objected to it only to put in a second three days later without her consent or any discussion with her. Tracey alleges the hospital's actions deprived his 63-year-old wife Janet of the right to life and subjected her to degrading treatment, while he was denied respect for his personal and family life. He is also seeking to force the coalition government to draw up a policy for England on the use of Do Not Attempt Cardio-pulmonary Resuscitation (DNACPR) instructions, and claims the present system of local policies is open to abuse.
Frances Swaine and Merry Varney are instructed by David Tracey, whose wife, Janet Tracey, sadly died in Addenbrooke’s Hospital on 7 March 2011. Following her admission to Addenbrooke’s, a ‘Do Not Attempt Cardio Pulmonary Resuscitation Order’ (known as a DNACPR or DNR) was placed on Janet’s medical notes. Janet was unaware of the DNACPR and when she became aware of it several days later, she clearly stated it was against her wishes and that she wanted to be resuscitated. As a result the DNACPR was cancelled. Several days later however a further DNACPR was entered onto her records. We have issued a judicial review and human rights claim against the NHS Trust responsible for Addenbrooke’s and against the Secretary of State for Health seeking Declarations from the Court that the Trust’s policy on the use of DNACPR is unlawful, and for the Secretary of State for Health to issue national guidance for patients and their families to know their rights concerning the use of DNACPRs.
On the face of it, the decision by a High Court judge in the case of M is no surprise - few would have expected a ruling to allow a patient with any level of consciousness and feeling to die. But a closer inspection of the 76-page judgement shows that Mr Justice Baker did not find his decision a straightforward one.
W (by her litigation friend, B) v M (by her litigation friend, the Official Solicitor) and others [2011] EWHC 2443 (Fam). Read judgment. In the first case of its kind, the Court of Protection ruled that withdrawing artificial nutrition and hydration from a person in a minimally conscious state was not, in the circumstances, in that person’s best interests. The Court also made general observations for future cases.
When faced with a terminal illness, medical professionals, who know the limits of modern medicine, often opt out of life-prolonging treatment. An American doctor explains why the best death can be the least medicated – and the art of dying peacefully, at home
In circumstances where life-sustaining treatment appears merely to be drawing out the inevitable, it is usual practice for the healthcare team to withdraw aggressive life-sustaining measures, once agreement is reached with the patient and their family. Common law gives doctors several defences to allegations of criminality or malpractice in taking the key actions that withdraw treatment and result in the patient's death; however, the legal defensibility of nurses undertaking this role has not been explored. In the absence of a specific body of law related to nurses taking the actions that withdraw life-sustaining treatment, I discuss the probable legal response by consideri
'Living wills' that stipulate exactly how a person wants to die should be drawn up with absolute clarity, a judge has ruled after concluding a 67-year-old man with motor neurone disease had made a "valid decision" to refuse treatment.
This application concerns AW, a 57-year-old woman who is in a permanent vegetative state. It is made by the NHS Trust responsible for her care, which seeks a declaration that it is lawful and in her best interests to withdraw active medical treatment, including specifically artificial nutrition and hydration, albeit that this will lead to AW's death. The application is supported by AW's family, by all the medical staff who look after her, by the evidence of the expert witnesses who have reported, and by the Official Solicitor on behalf of AW herself.