10/03/06 - Health news section
DOCTORS will face prosecution
if they refuse to allow patients to die in accordance with their
‘living wills’.By Steve Doughty, Social Affairs Correspondent
New laws will mean that, for the first time, instead of fighting to save lives, doctors will be required to end them.
The penalties for those who refuse to end life are set out in a code of practice on the workings of the new Mental Capacity Act, which was published yesterday. It says doctors must follow a living will – a patient’s instructions on what should happen if they become incapacitated – if it tells them to stop life-preserving treatment or remove tubes providing water and nutrition.
Doctors who refuse to obey living wills risk prosecution for assault and a possible jail sentence. The draft code appears to run contrary to the centuries-old Hippocratic Oath – the basic philosophy governing the medical profession – which urges that doctors should do no harm. Doctors, MPs and pro-life groups reacted with dismay and anger.
Leading consultant Philip Howard declared: ‘We are going to be criminalised if we try to save a patient. Can you imagine it? Doctors and nurses will go to jail and be struck off for trying to treat their patients. It is extraordinary.
‘My own position is that I would not withdraw treatment. I will risk prison.’ He added: ‘Someone deprived of water will die in ten to 14 days. It is a very horrible death.’ A conscience clause will allow doctors the freedom not to end treatment themselves, but they must pass the patient to another doctor who will. But Dr Howard, a London gastroenterology specialist, said: 'I do not think passing patients on is practical even if you regard it as the right thing to do, which I don't. At my hospital, my colleagues will take my view.'
Hugh McKinney, of the National Family Campaign, said: 'It is outrageous that doctors can be punished if they go against the very foundation of then profession. They will have to allow patients to die because of decisions that have, not been made by any medical professional.'
The British Medical Association, however, said it would not back doctors who defied living wills.
A spokesman said: 'Where a health professional deliberately attempted to frustrate the terms of a valid and applicable advance directive he or he or she would be acting outside the law and the BMA could not support them'.
The Mental Capacity Act, passed last year despite a rebellion by Labour MP's, had already been accused by critics of bringing in 'back-door euthanasia'.
Last night anti-euthanasia campaigners said they would challenge the law under human rights rules. Phyllis Bowman, of the Right to Life group, said: 'We are taking legal advice.'
'The Government left no stone unturned when it was trying to manipulate backbench MPs to get votes to push this law through.They swore, it would not be euthanasia. But now they are going to punish doctors who don't kill off their patients.'
Baroness Ashton, the minister responsible for the new Act at the Department for Constitutional Affairs, has been meeting Commons critics to try to minimise opposition.
But Tory MP Julian Brazier, who has called the law 'a step towards euthanasia', said: 'We had a very courteous discussion on the matter but we still don't agree about it.'
The code of practice - guidance for doctors, social workers, carers and families - was released in draft form yesterday for consultation among experts.
It encourages people ho make living wills in the same way they would make an ordinary will to order the disposal of their property.
Patients will be able to set out the conditions in which they would want life-saving treatment withdrawn. Treatment includes not just medical help, but also the provision of food and water by tube.Doctors who fail to remove tubes in such circumstances would be open to criminal charges of trespass or assault.
But medical professionals will not be liable for civil or criminal action if they treat patients who cannot speak for themselves, such as those incapacitated in accidents or by strokes or illnesses, where there is no known living will.
Giving legal force to living wills was a key aim of the Act. The guidance code suggests that those who have trade such wills should carry a card or wear a wristband to tell medical staff that one exists and where it is. Critics have dubbed them 'kill-me-off' cards.
A will may be left with a GP or lawyer or kept at home.
Directives which order that a patient be allowed to die must meet a series of conditions. They must be in writing and specify the treatment to be refused. The document must be signed by the patient - or by someone else in their presence while they are still capable of objecting - and a witness.
The Act also provides for' lasting powers of attorney', a system by which people can nominate someone else to take decisions over their care if they become incapacitated.
The Hippocratic Oath is the oldest tradition in medicine, named after Hippocrates, the Greek 'father of medicine' who lived from 460 to 380 BC.
About half the medical schools in Britain administer a version of the oath - others believe the language is outmoded.
The version most commonly used in this country was developed by the World Medical Association and last updated in 1994. Part of it states that 'a physician shall always bear in mind the obligation of preserving human life'.
• The code says patients who have lost the ability to speak for themselves may be used in medical experiments.
But researchers must observe 'stringent safeguards' to ensure they are not harmed or abused. They must consult family or carers before going ahead, and if no one is available they must appoint an independent individual to speak for the patient.
Carers can refuse a patient's participation. Research into new kinds of treatment will be allowed but not clinical trials of medicines.
Sign on the dotted line and vote to die. Make doubly certain by carrying a "kill me off" card at all times. And rest assured: a doctor who refuses to act as your executioner risks criminal prosecution.
A macabre fantasy? Not at all. This is the reality of the Government's Mental Capacity Act, arguably one of the most sinister laws ever foisted on this nation.
Yet it began with good intentions. There is nothing wrong with the principle that those who fear becoming too ill to manage their own affairs should be able to grant power of attorney to someone they trust.
But this Act also allows patients to draw up "living wills", giving these third parties power of life and death. When sick people fall into a coma, their representatives can order hospitals to withdraw food and water.
This is a world away from those sad circumstances where a doctor prescribes powerful drugs to ease the pain of a terminally ill patient, though they hasten the end. This is the legitimising of killing. And it is horrifically open to abuse.
What if patients change their minds about dying, but can't communicate? What if their representatives have ulterior motives for wanting them out of the way? How many ill, vulnerable people will feel subtly pressurised to give up, when the cash-strapped NHS needs their beds?
And it doesn't matter what doctors think, even though they are bound by their Hippocratic Oath. The guidelines say they must do as they are told.
So euthanasia comes to Britain by the back door. The moral and religious dimensions are brushed aside by a Government that forced this Act through on a three line whip, instead of treating it as an issue of conscience on a free vote.
So it is, in the sixth year of the 21st century, that Britain finally abandons the most fundamental principle of civilisation: the sanctity of human life.
Download and read the Draft Mental Capacity Act Code of Practice here