Posted on 11/17/2006 7:54:32 PM PST by FLOutdoorsman
The Lord Chancellor has warned doctors they risk going on trial for assault if they refuse to allow patients who have made 'living wills' to die.
Lord Falconer's message to the medical profession told doctors and nurses that new laws will require them to end lives rather than save them.
Those who decline to do so will face jail or, alternatively, big compensation claims in the courts.
Lord Falconer set out the determination of the Government to use draconian penalties to enforce living wills in a guide to Labour's Mental Capacity Act for doctors, nurses and social workers.
The law, which comes into operation next spring, gives full legal force to living wills, or advance decisions, in which patients say, sometimes years in advance, how they wish to be treated if they become incapacitated and lose the ability to speak for themselves.
In a living will a patient can demand that life-preserving treatment be withdrawn if they become too ill to communicate or feed themselves.
Critics say that for this reason the new law amounts to the introduction of euthanasia through the back door.
Death for those who have asked for it usually means the removal of tubes providing artificial nutrition and hydration so that a patient dies of lack of water and food.
The guidelines issued by Lord Falconer - with the backing of Health Secretary Patricia Hewitt - say that doctors may declare themselves conscientious objectors if they have religious or moral objections to carrying out the instructions of a living will.
But in that case a doctor must pass his or her patient over to another doctor who will follow the instructions to allow the patient to die.
The guidelines tell medical workers: 'You will not incur liability for providing treatment in a patient's best interests unless you a satisfied that a valid and applicable advance decision exists.
'If you are satisfied that an advance decision exists which is valid and applicable, then not to abide by it could lead to a legal claim for damages or a criminal prosecution for assault.'
An assault prosecution would mean that a doctor who refuses to kill a patient could go to jail. Conviction for actual bodily harm can carry a punishment of five years imprisonment.
The warning over damages claims raises the prospect that family or friends of a patient who have a financial interest in their death could sue a doctor who fails to kill them. It also opens the bizarre possibility that a patient who recovers could sue a doctor for not letting them die.
The ministerial guidance on the Mental Capacity Act comes in a week when the influential Nuffield Council on Bioethics recommended that premature babies born at 22 weeks or earlier should not be resuscitated, a suggestion that led to fears that the life-saving efforts of doctors will be bound by inflexible rules.
Now the guidelines on living wills has led, critics said, to the shadow of euthanasia over both ends of life.
Surgeon Dr Peter Saunders, head of the Christian Medical Fellowship, said: 'Clinical circumstances exist where it is entirely appropriate to withhold food and fluids: for example in a dying patient when their delivery proves both burdensome and ineffective for the patient.
'But we are concerned that patients will make unwise and hasty advance refusals of food and fluids without being properly informed about the diagnosis. It is too easy for patients to be driven by fears of meddlesome treatment and "being kept alive", into making advance refusals that later might be used against them.'
He added: 'Commonly patients change their minds about what care they would like, as their condition changes.
'This law does not allow real conscientious objection. A doctor who believes it would be clinically wrong to withdraw food and fluids must pass their patient over to another doctor who will do so. That makes them complicit in the death.'
Philosophy Professor David Conway of the Civitas think tank said: 'This is opening a terrible can of worms and it threatens to cause havoc.
'It would be impossible for a doctor to treat a patient in good conscience. What is a doctor supposed to do? This runs counter to the Hippocratic Oath that some still swear.'
'The best option would be for a doctor to find out if patients have made living wills and refuse to treat those who have.'
The guidance from ministers comes amid deepening concern over the implications of the Mental Capacity Act. The Act gives statutory force to the legal precedent set by the courts which says that it can be in the best interests of an incapacitated patient to be allowed to die through withdrawal of food and fluids.
But there has been alarm at the ease at which a patient can give instructions that they should die. Under the law, a living will that entails death needs to be in writing or included in medical notes, but will still be valid if a patient is too ill to sign their name to it.
The law also allows people to nominate a friend or relative with the power to order the withdrawal of life-preserving treatment if they become incapacitated - and to do so just by ticking a box on a form.
At one hospital trust in West London, doctors have already been provided with space in patients' notes to record requests that they be allowed to die if they become critically ill.
The Health Department also made clear in a court case last year that decisons on whether to provide a patient with life-saving treatment - such as provision of artificial nutrition and hydration - can be influenced by the cost of providing treatment.
The new guidelines make clear that doctors who obey living wills and allow their patients to die will not be faced with prosecution even if it turns out that the living will was not valid or did not exist.
They told doctors: 'If you reasonably believe that there is a valid and applicable advance decision then you will not be held liable for the consequences of abiding by it and not providing treatment.'
Academic lawyer Dr Jacqueline Laing of London Metropolitan University said: 'Many people will have filled in advance decision forms in ignorance of their lethal implications and of alternative courses of action. 'The Act inverts good medical practice by criminalizing medical staff who intervene to save the lives of their patients with simple cures and, in certain cases, even food and fluids. Any conscientious opt-out is nullified by the threat of prosecution.'
She added: 'The lethal direction of the Act and the cost-saving implications for the NHS should be obvious.'
Cue the Twilight Zone theme.
It looks as if the British Labour Party has decided to move past the Netherlands in the race to revive Nazi medical practices. Hitler would have been proud of this.
It's the end of the world as we know it...I feel fine.
And so it continues...step by step, increment by increment...
No simular penalties for denying "life-preserving treatment". I wonder why?
why not just simplify things? Anyone over the age of say 70 should go there local solyent green center to met a "peaceful" end.
ahh Secular humanism,like the flu in the spring, you just keep on working don't you?
Why not let people who have a living will die like they want to?
NOOOOOOOOOOOOoooooooooooooo! Not again
National health care $$$$. Treatment to preserve life costs too much.
Why not let people who have a living will die like they want to?
Let me answer your question with a question (if you don't mind)
Should doctors be in practice to save lives or to end them?
I find it mildly amusing to watch people posting about the beginning of the end, all the while trying to impose THEIR views on others.
Doctors should do all they can to save lives; but not to prolong them when there is no hope and the patient wishes to die with dignity in a way of their own choosing.
I don't think docotors should ever administer medicines or treatment to aid a death, but if a patient chooses no more treatment, I believe it's the patient's right to choose that and the doctor should honor that choice.
Thanks for posting. Interesting.
I agree 100 percent.
Especially the "one shot" thing......LOL.
I don't find it amusing at all Howlin.
I had a good friend who died just over 6 months ago ... young. Of leukemia.
He had been through hellish treatments and resusitating procedures. He indicated, after the last one, UCLA screwed up and saved him. He was miserable after so many high tech attempts to keep him from dying.
His parents finally intervened and he was allowed to die when the time came ... again.
Modern techniques prolong a natural death. Thanksfully, this young man is at peace now.
I can understand that, too; perhaps I'm just in a weird mood tonight, never knowing what new "injustice" will pop up on FR lately.
Bless them; that is a heavy burden for anybody, much less a parent.
See my experience with a young friend who had to die over and over again on post #19.
What part of the Hippocratic Oath don't they get?
Wow. They just can't wait for them to die fast enough over there, can they? Better hurry 'em along!
Boy, I sure wish WE had a nifty-keen national health service like the Brits! /sarc
All patients have the right to choose the medical care they want -- or don't want. Putting it in a living will is simply specifying in advance what you may not be able to communicate at a later time. I honestly can't understand what all the fuss is about.
Exactly. To me, it's just common sense. To others, it's an intolerable intrusion on medical prerogative. Both my parents made it crystal clear that if either or both had a hopeless diagnosis, they wanted no treatment at all except for pain, hydration and hygiene. When that day came, my sister and I made sure our parents' wishes were carried out to the letter. We checked up on hospital staff and hired outside professionals to come in every day and make sure nobody countermanded our parents' express wishes. They both died very naturally and peacefully, in complete comfort.
"Show me just what Mohammed brought that was new, and there you will find things only evil and inhuman, such as his command to spread by the sword the faith he preached." -Manuel II Paleologus
Did you read the article. Why. specifically, do you feel that a patients living will should not be respected?
Age 65 no dialysis, pacemakers or open heart surgery,
9 months to year wait for surgery considered elective,
congress will still have their own private medical plan, or like in GreatBritain go to private hospitals or go to India for surgery.
The average American's fine health-care choices will be diminished to the mediocrity of welfare choices.
The author of this article has worded it to get the response he wanted- to make it sound like we're discussing doctors loading up a needle with a killing cocktail and euthanising a patient. The author has sought to inflame readers and this is what he has done. But the actual facts in the article say nothing about this. What is being discussed is whether not providing treatment (at a patient's request) amounts to killing.
In any sane society- it does not. No doctor (or government) has the right to tell me to take treatment from a doctor. End of story.
Yeah, sounds real "progressive" doesn't it?
I agree with Howlin, a doctor must never administer something that causes death but there is a time to stand aside and let them go home to God.
The new guidelines make clear that doctors who obey living wills and allow their patients to die will not be faced with prosecution even if it turns out that the living will was not valid or did not exist....
(and) 'Many people will have filled in advance decision forms in ignorance of their lethal implications and of alternative courses of action. 'The Act inverts good medical practice by criminalizing medical staff who intervene to save the lives of their patients with simple cures and, in certain cases, even food and fluids. Any conscientious opt-out is nullified by the threat of prosecution.'
She added: 'The lethal direction of the Act and the cost-saving implications for the NHS should be obvious.'
To spell it out for you:
Sometimes I wonder if England is worth saving.
(1) the right of patients, especially in terminal illness, to refuse treatments which are futile, experimental, "heroic," or excessively burdensome,
(2) the right of ALL patients, even if uncommunicative or severely ill or disabled, to receive ordinary care: nutrition, hydration, pain management, hygienic and comfort care, and
(3) the deliberate causing of death by active killing or by medical abandonment.
Briefly, a patient certainly is morally and legally justified in opting out of "extraordinary" treatments --- ventilator, dialysis, surgery, radiation, chemo, whatever --- if in their judgment such intervention is futile and burdensome. A patient also has a right, always, to "ordinary" care: the right not to die hungry, thirsty, cold, filthy, in pain, and, humanly speaking, abandoned. In terminal cases, it is common and quite justified to choose effective pain management (e.g. morphine at adequate levels) even if it is foreseen to somewhat reduce the expected span of survival.
However, active killing, medical abandonment, causing the patient to die of starvation/dehydration, or to die of curable disease (e.g. respiratory infection which should have been quickly and routinely controlled by an antibiotic) --- this is unethical, it puts truly murderous power in the hands of state agencies, and it has nothing to do with a patient's legitimate medical choice. For the further implications, I urge you to read The Nazi Doctors by Robert Jay Lifton, and Useless Eaters by Mark P. Mostert.
Bingo!
No. The article does not say that. The doctor makes no decisions in this regard. It is the family.
I refer you to this sentence from the article:</p>
"The new guidelines make clear that doctors who obey living wills and allow their patients to die will not be faced with prosecution even if it turns out that the living will was not valid or did not exist."
But this is obvious. There is nothing wrong there. Not providing treatment or necessary care is not killing someone. If it is the liberals could argue that we kill millions in Africa every year by not feeding them and taking care of them when we are capable of doing so.
It's not as if a doctor has a right to intervene when he thinks it's necessary. If he has no reasonable cause to believe a living will is not legitimate he has no right to intervene. What would you prosecute the doctor for anyway? If you're bankrupt and I don't give you money- even though I have millions- it doesn't make me culpable of anything.
It's no different from hiring a lawyer. If you decide you don't need the lawyer and tell him his services are no longer needed, that's that. Same with a doctor. A doctor is merely a technician. No special rights to intervene.
"The article does not say that. The doctor makes no decisions in this regard. It is the family."
The article does not say that and also the applicable act (The Mental Capacity Act 2005) does not say that.
What it does say is:
"A person does not incur liability for the consequences of withholding or withdrawing a treatment from P if, at the time, he reasonably believes that an advance decision exists which is valid and applicable to the treatment."
(P referring to the patient).
I have nothing against a living will and a patient's right to not be treated. I am aghast, however, that anyone thinks it a good idea to make the process that easy. It's like Motor Voter for death. The potential for abuse and fraud are too great.
"If the old person has Alzheimer's or is otherwise mentally incapacitated (even temporarily by illness), it is not hard to imagine that family member checking the "box" on the form that says, "Yes, Grandma wanted to die"."
That isn't a living will.
The patient may have made a living will stipulating that that family member could make that decision. Which is up to them if they want to do that.
You ignored the salient fact --- spelled out quite clearly in the article --- that that doctors will not be prosecuted for causing a patient's death "even if it turns out that the living will was not valid or did not exist."
"Not providing treatment or necessary care is not killing someone. "
That's true if you have no responsible, familial, or professional relationship with the person: the general "hungry people in Africa" situation.
But if you are a family member, a a guardian or caregiver, or a medical professional in a doctor-patient relationship, you certainly must not allow your dependent to die of starvation/dehydration or medical abandonment.
Note that we are not speaking here of choosing a conservative treatment option. We are speaking of intentionally causing the patient's death, either by an act of killing (e.g. lethal drug dose) or by withdrawing the basic and universal requirements of survival (e.g. food and water.)
A living will can require that "extraordinary means" to save or prolong life mustbe abandoned under certain carefully specified conditions, with only palliative care being authorized (that in fact is the situation of my father at this moment, who is receiving hospice care here in my home); it cannot "authorize" death by starvation and neglect.
What would you prosecute the doctor for anyway?
Depends on just exactly what he did, or failed to do. Criminal abuse. Gross negligence. Medical malpractice.
"Doctor is merely a technician. No special rights to intervene."
Certainly a doctor has no right to force aggressive treatments on a nonconsenting patient. That would be assault. But doctors are not exactlythe same as lawyers, in this respect: they have life or death power over thei patients; the results of their decisions can be extreme and irrevocable; and they have an ethic of care (Hippocratic Oath and related medical-ethical commitments) which goes beyond the analogy of a lawyer-client relationship.
The doctor's relationship with the patient is fiduciary, in that he is charged by law and equity with a higher duty of care for another person. A fiduciary is required by law to place the other person's interests equal to or ahead of his own in all dealings involving that other person.
Especially in a situation like that in Britain, where healthcare is a virtual monopoly of the state, it is essential to clarify that the doctor has a prior ethical responsibility to the health of the patient.
Dying may be allowed to occur naturally, with the patient supported by "palliative care" limited to nutrition, hydration, pain management, hygienic, and comfort care. But that is not "choosing death"; it is choosing ordinary care. Death itself cannot be the doctor's direct goal, since he is committed to the patient's healthcare, and the patient is never healthier dead.
The law also allows people to nominate a friend or relative with the power to order the withdrawal of life-preserving treatment if they become incapacitated - and to do so just by ticking a box on a form.
So my point is that while that may not be a living will in your definition, the law crafted in Britain does define it so, and this is the point of my post, and my statement of concern.
As an aside, over the years I have seen many intelligent FReepers post about why laws should be CAREFULLY made, disected, and scrutinied, in order to ensure that the law didn't produce unintended consequences. I believe that is true conservative thinking, and such scrutiny serves us all well. It appears that politicans, in order to stay popular and elected, often are quick to come up with a law that appears to satisfy an emotion need in the voters, but then comes back to haunt and harm us all. This happens entirely to often.
Rarer still, is a law that spells out how it would be harmful for all, as this one does. I think they should work on the wording to ensure only those with well crafted, witnessed and notarized living wills are enforced, even to the point of of jailing the treating physician. Otherwise, a situation than can easily be gamed will be created, and doctors will be too fearful to object.
You don't see my point?
"Note that we are not speaking here of choosing a conservative treatment option. We are speaking of intentionally causing the patient's death, either by an act of killing (e.g. lethal drug dose) or by withdrawing the basic and universal requirements of survival (e.g. food and water.)"
I believe you may be correct on the second one (a living will can specify a refusal of a specific course of treatment). But you are completely wrong on the first, that would be an illegal act by the doctor.
Whatever. No doctor has the right to do anything to me. If I want to die, no doctor has the right to interfere. If you want to construe this as the doctor killing me- that doesn't bother me- by all means go right ahead and construe. It doesn't change anything.
If the person concerned has made a living will authorising that relative to do so. You quote the part of the article that says this:
"The law also allows people to nominate a friend or relative with the power to order the withdrawal of life-preserving treatment if they become incapacitated"
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