18/01/06 - Health news section
By Steve Doughty Social Affairs Correspondent
DOCTORS play a part in nearly two in three patient deaths, an inquiry into the ethics of ending life has claimed.
Around
180,000 patients a year, or one third, die after doctors decide
to withdraw or refuse them treatment, the research suggested.
Another third of deaths involve a doctor giving pain relief to
a patient in a way which shortens their life. And around one death
in 250 is caused by a doctor actively attempting to kill a patient
- illegal euthanasia.
The inquiry into the extent of euthanasia raised fears that many doctors are opting to allow patients to die who might live if treated.
The survey of the experiences of 857 doctors found that - if their practices apply across the medical profession - more than 30 per cent of deaths involve a medical decision to withdraw or withhold treatment.
Such decisions can involve patients with terminal diseases who refuse operations because they would limit quality of life. They also cover sick and dying elderly people whose families agree with doctors that lives should not be prolonged with drugs.
But allegations that some deaths involve doctors refusing to give elderly patients water or food without the consent of their families provoked controversy.
MPs said the scale of the figures for deaths involving withdrawal or withholding of treatment was `disturbing' and `worrying'.
The pioneering research among doctors by Professor Clive Seale of Brunel University suggests levels of non-treatment deaths in this country are topped only by those in Switzerland, where assisted suicide is legal.
Professor Seale's research, to be published in the journal Palliative Medicine, drew half its responses from GPs and half from medical doctors.
It asked about 'end-of-life decisions' where the doctor played a central role in choosing a course of action that resulted in the patient's death.
The professor said that one death in 250 can be described as 'doctor-assisted dying'.
These illegal deaths, around 3,000 a year in total, include 1,000 cases of `voluntary euthanasia' in which the patient agreed with the doctor that they should die, and 2,000 of `ending of life without an explicit request'.
The research showed there were no cases at all in which a doctor helped a suicide. Nearly a third of all deaths, 52.8 percent, around 200,000, involved a doctor, giving pain relief to a patient in such a way that it shortened their life.
Deaths caused by these attempts to alleviate pain are known as `double effect' deaths.
They cause' little controversy - Church leaders including those of the Roman Catholic Church, and right-to-life campaigners acknowledge the concern of doctors to ease the suffering of patients and accept that sometimes it may shorten life.
But, more controversially, caused by what the study called 'non-treatment decisions' which involve with-holding or, withdrawing treatment.
Professor Seale said:
`A typical case of a non treatment decision would involve a frail and vulnerable elderly person who develops a chest infection.
'The decision would be whether or not to use antibiotics - the family would be consulted and the choice would be to let nature take its course.
`Such a case would not be controversial. But there are cases that are controversial.'
He added:
`We have a very strong ethos of providing excellent palliative care in the UK reflected in the finding, that doctors are willing to make other kinds of decisions that prioritise the comfort of patients, without striving to preserve life at the cost of suffering.
'The results suggest that providing the best kind of patient care is a major driver behind medical deicison making.'
But his findings provoked alarm among MPs and campaigners against mercy killing.
Tory MP Julian Brazier said:
`This is a disturbing level of deaths through withdrawal of treatment and there must be further investigation.
`This is a very high figure indeed.'
Labour's Jim Dobbin, chairman of the all-party, pro-life committee, called the numbers `huge' and said the rate of withdrawal of treatment must be questioned.
The figures provoked a furious response from SOS - NHS Patients in Danger, a group formed by families of patients who died after withdrawal of treatment without the consent of relatives.
It said the figures exposed `outrageous torture and elimination of the elderly'. Relatives, demanded a full scale public inquiry into the real extent of doctor-assisted death. The findings follow a political row last year over the Government's Mental Capacity Act which gave legal force to `living wills'.
These documents mean anyone can set down their future treatment should they become too ill to speak or choose.
They can instruct doctors to withdraw treatment and have been
condemned as `back door euthanasia'.
One group of NHS hospitals has also established a `tick the
box and die' scheme. In the four hospitals of the Hammersmith
Hospital Trust in West London,
patients can indicate whether they wish to be allowed to die through
withdrawal of treatment if they become critically ill.
A spokesman for the British Medical Association said:
`Withdrawing treatment is legal within strict guidelines.
`Medicine should be seen to benefit patients and when it can no longer do so difficult decisions need sometimes to be made in patients' best interests.
`This may sometimes involve withholding life-prolonging treatments.'
PROFESSIONAL guidance for doctors since the 1990s has said they must act in the `best interests' of the patient In deciding whether to withhold or withdraw treatment.
But there has been controversy over how this is interpreted. In 1993, the Law lords ruled that a victim of the Hillsborough football disaster should be allowed to die by removing tubes providing him with food and water. This Introduced the precedent that doctors could decide that dying might be In a patient's best interests.
The Mental Capacity Act (2005) also gives legal force to
living wills, in which patients can ask for treatment such as
hydration and nutrition to be ended.