A patient cannot demand a particular form of treatment - that is a matter for the judgment of the doctor. He or he can, however, refuse.

Para 2.5, "Who Decides? Making Decisions on Behalf of Mentally Incapacitated Adults", a consultation paper issued by the Lord Chancellor's Department, December 1997

The Law Commission made it clear ... that if an advance refusal has been made then a treatment provider cannot rely on the authority which would otherwise enable a patient without capacity to be treated reasonably and in his or her best interests.

Para 4.17, as above

If we can get people to accept the removal of all treatment and care - especially the removal of food and fluids - they will see what a painful way this is to die and then, in the patient's best interest, they will accept the lethal injection.

Dr. Helga Kuhse, speaking at the Fifth Biennial Congress of Societies for the Right to Die, held in Nice, September 1984

Why shouldn't I give instructions here and now about how I want to be treated at the end of my life?

Only your refusal of treatment is binding on the doctor.

A Living Will or Advance Directive comes into force when you are unfit to be consulted, and the doctor can decide when that is. If you had been sedated you might be unable to speak for yourself. You might also be unable to feed yourself or pour out a glass of water. If you have signed the most common type of Living Will, a doctor is forbidden to provide intravenous fluids, or tube feeding: it might be considered an assault. This means that you would become dehydrated and die for lack of water.

This could also happen if you were unable to communicate after an accidental injury or a stroke.

The best treatment, aimed at returning you to health, might also be ruled out if you had signed a Living Will. You might live on needlessly disabled.

How can I prevent my life being prolonged artificially?

I wouldn't want to live if I couldn't do all the things I used to do.

A lot of people feel like that before it happens, but we are more adaptable than we think. If we become disabled we find it's not impossible to cope with, after all, and life is still worth living.

A study of patients in hospital aged 80 and over, published in the Journal of the American Medical Association on February 4th 1998, found that when asked to choose between a shorter lifespan with a higher so-called "quality of life" or longer lifespan with a lower "quality", most chose the longer lifespan. "48% were unwilling to exchange any time in their current state of health for a shorter time in excellent health, and 27.8% were willing to give up at most 1 month of 12 in return for excellent health," the authors reported.

Do I have a duty to die if I should need nursing care when I get older?

Is death from lack of water an easy way to go?

No. It may take 10 days or more if the patient is not terminally ill. It causes severe kidney pain, among other symptoms. Sedation may not be able entirely to prevent pain and discomfort, though it prevents communication.

In a letter to The Times on 28th June 1999 a daughter reported what happened to her elderly mother who was taken to hospital with a fractured skull and severe brain damage. At first she was put on an intravenous drip. "Two and a half weeks later the drip came out of its own accord and was not re-inserted. We were not consulted but did not object because we thought she would die more quickly. We then watched over her for the seven agonising days it took for her to die of dehydration..." The daughter called it "an appalling end."

If Living Wills are bad for patients, why do the authorities promote them?

Advance Directives were launched in the U.S.A. in 1969 in a law journal article entitled "Due Process of Euthanasia: The Living Will, a Proposal." In 1977 Robert Derzon, a Health Dept. official, advised President Carter to "change social values regarding cost-inducing activities," and stated "The cost-saving from a nation-wide push toward Living Wills is likely to be enormous. Over one-fifth of Medicare expenditures are for persons in their last year of life." In 1991 it was made compulsory for all patients admitted to hospital in the U.S., for whatever reason, to be presented with "Living Will" forms.

Dr. Michael Irwin, a leading member of Britain's Voluntary Euthanasia Society, reported in a letter to the Journal of the Royal Society of Medicine (Vol.93, July 2000) that "When the Dept. of Family Medicine at Jefferson Medical College, Philadelphia reviewed the records of 474 Medicare patients who had died in hospital (in 1990, 1991 and 1992) it was discovered that the mean inpatient charge for the 342 patients without documentation of a discussion of advance directives was more than three times that of the 132 patients with such documentation ($95,304 versus $30,478)."

Are living wills the only danger to patients?

No. In the U.S.A. Steven Becker, aged 29, refused to sign one when he was admitted to hospital for a brain operation in March 2000. After the operation he was considered "vegetative", although a neurologist thought he might recover. Against some family members' wishes, in September a judge ordered him to be deprived of fluid, and he died. Nancy Valko, a pro-life nurse, commented "It makes you wonder why there is such a push to have people sign such documents when not signing one is considered no obstacle to still getting you dead."

In 1999 the Medical Ethics Committee of the British Medical Association issued guidelines on "Withholding and Withdrawing Medical Treatment" in which they informed doctors that it was not only ethical but legal to allow certain categories of patients to die of dehydration, without their having signed a Living Will, and that a court's permission was not needed (at the time this was doubtful). Disabled newborns, patients with Alzheimer's disease and victims of a stroke, who might be fully conscious but unable to swallow properly, were thought to be suitable candidates for death by neglect.

In 2002 the General Medical Council, also, issued Guidelines which allowed doctors to end patients' lives. Leslie Burke, who has a condition which will make him need tube feeding, challenged the G. M. C. in court and Mr Justice Munby in 2004 found the guidelines to be incompatible with the European Convention on Human Rights. The G.M.C. appealed against his judgment and the Secretary of State for Health supported them, claiming it would cost too much to give food and water via a tube to every patient who needed it. Judges in the Appeal Court duly overturned the Munby judgment on 28th July 2005. Leslie Burke hopes to get leave to appeal to the House of Lords.

The recent Adults with Incapacity (Scotland) Act allows dehydration in the patient's "best interests" for someone who can't communicate, if a proxy and a doctor agree on this. The English version of the law, the Mental Capacity Act was passed on May 3rd 2005. This Act, which will come into effect in 2007, makes it advisable to put your wishes down on paper.

How can I avoid mistreatment in hospital which is intended to end my life?

A Protective Document has been issued in the U.S.A. by the International Task Force on Euthanasia and Assisted Suicide. An English version, the "A PATIENT'S CLAIM TO LIFE," is available from ALERT. Although it might not be legally binding on doctors in this country, it would prevent misrepresentation of your wishes if you should be in hospital and unable to speak for yourself.

Write to your Member of Parliament and protest against patients being caused to die by the withholding of water.

BRITAIN SHOULD DO BETTER THAN THIS FOR ELDERLY AND DEFENCELESS PEOPLE.