Doctors will be able to decide to end the lives of patients with severe dementia or other degenerative diseases if proposals from their own leaders are adopted.
The guidelines say consultants or GPs should be allowed to remove tubes giving food and water to those who cannot feed themselves – even if they could otherwise live for years.
The British Medical Association proposals mean patients who could otherwise have survived for years may have their lives ended by the withdrawal of nutrition and hydration tubes.
However, the British Medical Association proposal to withdraw nutrition and hydration tubes was condemned as ‘euthanasia by stealth’ yesterday.
BMA officials produced the proposals in response to legal test cases in which judges ruled that NHS staff and officials no longer need a court’s permission to withdraw artificial nutrition and hydration from a patient who is incapacitated and unable to speak or feed themselves.
Doctors could end the lives of patients with severe dementia and other degenerative diseases (stock)
Last month, Supreme Court justices endorsed the right of doctors to remove ‘clinically-assisted artificial nutrition and hydration’ on their own authority with the agreement of a patient’s family.
Removal of the tubes means that an incapacitated patient will die of thirst and starvation after a short period.
The draft proposals being circulated by the BMA say doctors should be able to end the lives not only of patients close to death or in deep comas – in vegetative or minimally conscious states – but of those suffering from much more common degenerative conditions, including advanced dementia.
The document said those affected included not only deeply incapacitated patients but ‘the much larger group of patients who have multiple co-morbidities, frailty or degenerative neurological conditions’.
Around 850,000 people are thought to have dementia in Britain, with the figure expected to exceed a million by 2025.
The BMA document said its new rules should cover ‘those patients who have a recognised degenerative condition – such as advanced dementia, Parkinson’s or Huntington’s disease – that is likely to result in the patient being unable to take sufficient nutrition orally’.
It added: ‘Due to the degenerative nature of their condition, these patients are on an expected downward trajectory and will inevitably die, usually as a result of their underlying condition, although perhaps not imminently and could, potentially, go on living for many years.’
Stroke patients and those with ‘rapidly progressing brain injury’ could also be included.
Guidelines say consultants or GPs should be allowed to remove tubes giving food and water to those who cannot feed themselves (stock)
Decisions on removing nutrition and hydration tubes should be taken by consultants for hospital patients, or GPs for those in nursing or residential homes or living in their own homes.
However, families or friends should be consulted, usually through ‘best interests meetings’ set up to decide whether it would be better for a patient to live or die.
But doctors and campaigners opposed to euthanasia and the deliberate termination of life by medical staff criticised the suggestion last night.
Dr Peter Saunders, of the group Care Not Killing, said: ‘This is a recipe for euthanasia by stealth, but all in the name of autonomy and best interests – the very worst kind of doctor paternalism justified on the grounds that the patient would have wanted it.
‘There are conceivably tens of thousands of patients in England and Wales who are vulnerable to the use and abuse of this guidance.
‘It will be almost impossible to work out what has happened in a given case and there are no legal mechanisms in place for bringing abusers to justice.’
Professor Patrick Pullicino, of East Kent Hospitals University NHS Trust, the consultant who helped expose wrongful hospital deaths under the discredited Liverpool Care Pathway, said the BMA plan was ‘terrible’.
He added: ‘It codifies current practices of withdrawing food and fluid at the end of life and thereby encourages it.
‘It facilitates the extension of end-of-life pathways to people with neurological diseases who are not dying, which is a very negative thing because there are a lot of disabled neurological patients.
‘It perpetuates the myth of ‘best interests’, which has been shown to be erroneous and reflective of members’ views and not of the real best interests of the patients.’
The BMA paper says that in cases where patients die after the withdrawal of nutritition and hydration tubes, this should not be mentioned on death certificates. Instead only the underlying original condition should be given.
Professor Pullicino said this ‘directs doctors to falsify death certificates. It tells doctors to put down the pre-existing condition and not that they died of dehydration. It will totally conceal the statistics of patients who are being dehydrated to death.’
Doctors are told that to decide whether a patient’s best interests lie in living or dying and should consider the chances that a condition could improve
Doctors are told that to decide whether a patient’s best interests lie in living or dying they should consider the chances that their condition will improve, what their quality of life is, and what their views on whether they wish to live on in their condition are likely to be.
Friends and family should be consulted, the document said, but should not have the final decision.
The test case decision that first allowed doctors to decide their patients should die was made by the Law Lords in 1993.
They said 22-year-old Tony Bland, a Liverpool football supporter who suffered severe brain damage in the crush at Hillsborough football stadium in April 1989, should be allowed to die.
The landmark Bland ruling set down that artificial nutrition and hydration by tube are not normal feeding but medical treatment. It also said that it might not be in a patient’s best interests to be treated, and if medical treatment is not in the best interests of a patient who cannot speak for themselves, it can be stopped.
The legal pendulum swung further towards allowing patients to die in 2005 with Tony Blair’s Mental Capacity Act, which said nutrition and hydration tubes should be withdrawn if an incapacitated patient had left an advance directive, or living will, saying they wish to end their treatment if they become too ill to speak for themselves.
However the Mental Capacity Act was ambiguous on the question of whether the courts should always be involved when doctors decide a patient should die.
The BMA document was circulated in June following court rulings in 2017 which, it said, meant there was no requirement for court approval before removing nutrition and hydration tubes.
Last month the country’s highest appeal court, the Supreme Court, ruled in the test case of a patient known only as Y that doctors can decide a patient should die without reference to a court.
A spokesman for the BMA said decisions surrounding the withdrawal of clinically-assisted nutrition and hydration (CANH) presented ‘clinical, ethical and legal challenges’.
He added: ‘Following a number of legal developments, the BMA has been working with the Royal College of Physicians and the General Medical Council to produce guidance on best practice for health professionals when facing decisions about CANH.
‘CANH is a form of medical treatment. The aim of medical treatment is not simply to prolong life at all costs, and the courts have been clear that in some circumstances it will not be in the best interests of the individual patients to receive it.
‘Those making these decisions must do so in full dialogue with families to determine what is right for the individual patient, and of course, when there is any disagreement the court still has an important role to play.
‘We shared the draft guidance in confidence with legal and health professionals and organisations and patient support groups to seek their views. The final version will reflect last month’s Supreme Court judgment when it is published this year.’
It’s the most chilling thing I’ve ever heard
Sian Vasey, 62, (pictured) described the British medical councils plans as the most chilling thing she’s ever heard
Sian Vasey, who suffers from spinal muscular atrophy, yesterday described the BMA plans as ‘the most chilling thing I have ever heard’.
Miss Vasey said: ‘If I reach the point where I can’t eat, drink or talk then I am in trouble.
‘It is already the case that I can’t feed myself.
If the talk goes I would have to rely on somebody to speak for me. It’s a nightmare.
‘I worry about what will happen if I have to go into hospital. Often people are admitted to hospital unable to speak or move, but they get better.
‘Under these rules many will not have a chance to get better.’
Miss Vasey’s condition means that she has never been able to walk and that she needs carers to provide routine help, including help with eating and drinking.
Spinal muscular atrophy leaves sufferers with weak limbs and movement problems, together with difficulties in swallowing and breathing.
The effects of the condition often get worse over time.
Miss Vasey, 62, who lives in West London, has no close family to look after her and would rely on friends to speak for her should she be admitted to hospital.
‘I did have to go into Ealing hospital recently with a broken arm,’ she said. ‘I need someone to help me eat and drink and so I asked if someone could stay with me.
The hospital didn’t like that at all – they were very aggressive about it and said that I could not have someone beside me. But I rely on having someone there to help me eat and drink.’
Miss Vasey, who campaigns on behalf of the disability group Not Dead Yet, is among disabled people who would like to be able to write a living will requesting that she continue to be treated should she be admitted to hospital unable to speak for herself.
However, the only living wills which have legal force and which doctors must abide by are those which require medical staff to withdraw treatment.
Under the law, hydration and nutrition provided to incapacitated patients by tube counts not as basic care, but as medical treatment.