Are Doctors Infallible? March 2003 In another atmosphere the new policy announced at the Hammersmith hospital would be wholly commendable. Elderly patients are to be asked to sign a `living will' to say whether they would want resuscitation or artificial feeding in the event of serious and potentially terminal illness. Thus will be avoided many inappropriate resuscitation and aggressive death-defying treatments which merely ensure that the patient takes longer to die. And on the other hand patients would not be written off and neglected if their own priority was to be kept alive longer, however burdensome the treatment or slender its chance of success. The patient's own priorities would direct the medical team. But against the background of current medical tendencies, it is in fact not so straightforward. Of course doctors do not have to give any treatment which they know would be futile just because a patient has heard of it and demands it. But recent guidelines from the British Medical Association claim the right for doctors to decide that even food or water may be `futile' for a patient who cannot even swallow or communicate. So we are in fact faced with a situation where patients can refuse treatment, but not demand it. Death is an option, but life is in the gift of the doctors. If doctors had not claimed this power, the Hammersmith living will would be an admirable acknowledgement of patient autonomy. But since they have claimed the power to decide who ought to die, the living wish actually increases the patient's danger. Having only said they do not want excessive treatment, they may actually be laying themselves open to be actively killed. For example someone incapacitated by a stroke might not be cared for long enough to see if they would recover. The views of their families would be safely ignored because the living will had been signed some time ago. Some balancing defence for patients is needed to limit this absolute power, lest shortage of resources or beds, or just laziness, colour the doctors' decisions. It is always dangerous to let any group of people become familiar and comfortable with the decision to bring about someone else's death. Kings abused it, judges abused it, and we withdrew the power of life and death from both. Will doctors be any more infallible? Dr Richard Lamerton UK Hospital's new policy puts pressure on people to refuse treatment Published by ALERT 27 Walpole Street, London SW3 4QS. Telephone 020 7730 730 2800. Fax 020 7730 0181.