Dehydrate dementia patients to death to save money: British Medical Journal editorial

by Hilary White, Rome CorrespondentMon Jul 16, 2012 15:38 EST

July 16, 2012 (LifeSiteNews.com) – The courts should not interfere with doctors who want to dehydrate to death incapacitated patients who are a drain on scarce financial resources, according to an editorial in this week’s edition of the prestigious British Medical Journal.

Raanan Gillon, emeritus professor of medical ethics and former chairman of the Institute of Medical Ethics governing body, wrote that a ruling last year by the High Court against dehydrating an incapacitated patient to death was “profoundly disturbing” because it took the life and death decision-making power out of the hands of doctors and required that the principle of the “sanctity of life” take precedence over other considerations.

The judgment, he said, “threaten[s] to skew the delivery of severely resource-limited healthcare services towards providing non-beneficial or minimally beneficial life prolonging treatments including artificial nutrition and hydration to thousands of severely demented patients whose families and friends believe they would not have wanted such treatment”.

He complained that the ruling required that, under the “stringent” Mental Capacity Act, in order to remove “life prolonging treatment” like a feeding and hydration tube, the patient himself must have left a legally binding “advance decision” in writing, and that previous casual or unrecorded statements to relatives were not sufficient grounds.

The editorial, titled, “Sanctity of life law has gone too far,” said that unless it is overturned, the court ruling “will gradually and detrimentally distort healthcare provision, healthcare values, and common sense.”

Its logical implication, Gillon wrote, is that “doctors should no longer decide, in consultation with those who know their incapacitated patients, whether life prolonging treatment including artificial nutrition and hydration will be in their patients’ best interests.”

Furthermore, he said, the ruling logically means that those patients in “a higher than minimal state of consciousness must be similarly protected”.

The court ruling in question was that in the M Case, in which the family of a 52-year-old woman who was found to be in a “minimally conscious state” and who was “otherwise clinically stable,” were petitioning the court to have her feeding and hydration tube removed. The Court of Protection ruled that all patients in such a state must be referred individually to the Court of Protection if “life prolonging treatment” by artificial nutrition and hydration is to be withheld or withdrawn.

Mr. Justice Baker said in the September 2011 decision, “The factor which does carry substantial weight, in my judgment, is the preservation of life. Although not an absolute rule, the law regards the preservation of life as a fundamental principle.”

Justice Baker wrote that the courts should not “attach significant weight” to the patient’s previous statements unless they had been expressed in a way that could stand up to legal scrutiny. As in the case of Terri Schiavo in the U.S., M’s family had argued that her alleged previous statements indicated that she would not want to be dependent on such care.

Baker responded to this by ruling, “[Given] the importance of the sanctity of life, and the fatal consequences of withdrawing treatment, and the absence of an advance decision that complied with the requirements previously specified by the common law and now under statute, it would in my judgment be wrong to attach significant weight to those statements made prior to her collapse.”

Anthony Ozimic, communications manager for the Society for the Protection of Unborn Children, said that the ideology being espoused by Gillon and the British Medical Journal is indistinguishable from the materialist utilitarian ethic that led to the elimination of the “unfit” by eugenicists in the early 20th century, including in pre-World War II Germany.

“What is particularly disturbing about Professor Gillon’s opinions is that he is judging certain disabled people as having lives unworthy of life, balancing those lives against the needs of other patients and seeking to justify killing the disabled on the grounds of rationing,” Ozimic told LifeSiteNews.com.

“Such a utilitarian calculus is in substance no difference to the calculus made during World War II by the German authorities: that the disabled should die so that wounded soldiers could live. In any case, assisted food and fluids are basic nursing care, not futile medical treatments.”

As shocking as such pronouncements are to the general public, the idea that disabled patients should be euthanized, either directly or by the removal of food and hydration, is actually a mainstream of thought among many of the western world’s medical ethicists. Gillon himself is a major voice in the field as a former editor of the Journal of Medical Ethics and the author of the 1985 book “Philosophical Medical Ethics”.

Classical medical ethics, that held as paramount the principle “Do no harm,” has in large part been set aside in favor of the new utilitarian-based Bioethics, a formal or “normative” branch of ethical philosophy that seeks “the greatest good for the greatest number” according to the “principles” of “justice, beneficence and autonomy”.

Few medical schools today require students to recite the classical version of the oath.

Hippocratic Oath: Classical Version

I swear by Apollo Physician and Asclepius and Hygieia and Panaceia and all the gods and goddesses, making them my witnesses, that I will fulfill according to my ability and judgment this oath and this covenant:

To hold him who has taught me this art as equal to my parents and to live my life in partnership with him, and if he is in need of money to give him a share of mine, and to regard his offspring as equal to my brothers in male lineage and to teach them this art—if they desire to learn it—without fee and covenant; to give a share of precepts and oral instruction and all the other learning to my sons and to the sons of him who has instructed me and to pupils who have signed the covenant and have taken an oath according to the medical law, but no one else.

I will apply dietetic measures for the benefit of the sick according to my ability and judgment; I will keep them from harm and injustice.

I will neither give a deadly drug to anybody who asked for it, nor will I make a suggestion to this effect. Similarly I will not give to a woman an abortive remedy. In purity and holiness I will guard my life and my art.

I will not use the knife, not even on sufferers from stone, but will withdraw in favor of such men as are engaged in this work.

Whatever houses I may visit, I will come for the benefit of the sick, remaining free of all intentional injustice, of all mischief and in particular of sexual relations with both female and male persons, be they free or slaves.

What I may see or hear in the course of the treatment or even outside of the treatment in regard to the life of men, which on no account one must spread abroad, I will keep to myself, holding such things shameful to be spoken about.

If I fulfill this oath and do not violate it, may it be granted to me to enjoy life and art, being honored with fame among all men for all time to come; if I transgress it and swear falsely, may the opposite of all this be my lot.

Hippocratic Oath: Modern Version

I swear to fulfill, to the best of my ability and judgment, this covenant:

I will respect the hard-won scientific gains of those physicians in whose steps I walk, and gladly share such knowledge as is mine with those who are to follow.

I will apply, for the benefit of the sick, all measures [that] are required, avoiding those twin traps of overtreatment and therapeutic nihilism.

I will remember that there is art to medicine as well as science, and that warmth, sympathy, and understanding may outweigh the surgeon's knife or the chemist's drug.

I will not be ashamed to say "I know not," nor will I fail to call in my colleagues when the skills of another are needed for a patient's recovery.

I will respect the privacy of my patients, for their problems are not disclosed to me that the world may know. Most especially must I tread with care in matters of life and death. If it is given me to save a life, all thanks. But it may also be within my power to take a life; this awesome responsibility must be faced with great humbleness and awareness of my own frailty. Above all, I must not play at God.

I will remember that I do not treat a fever chart, a cancerous growth, but a sick human being, whose illness may affect the person's family and economic stability. My responsibility includes these related problems, if I am to care adequately for the sick.

I will prevent disease whenever I can, for prevention is preferable to cure.

I will remember that I remain a member of society, with special obligations to all my fellow human beings, those sound of mind and body as well as the infirm.

If I do not violate this oath, may I enjoy life and art, respected while I live and remembered with affection thereafter. May I always act so as to preserve the finest traditions of my calling and may I long experience the joy of healing those who seek my help.

—Written in 1964 by Louis Lasagna, Academic Dean of the School of Medicine at Tufts University, and used in many medical schools today.

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