Mar 28, 2002
By Richard Woodman
LONDON, (Reuters Health)
Most doctors would be prepared to end a patient's treatment even knowing that doing so would kill them, according to a snap survey carried out by the British Medical Association's magazine BMA News Review.
Among respondents, 61% said they would personally be prepared to end a patient's treatment if they had been asked to do so by the patient, knowing that it would end life.
However, 39% said they would not or were not sure.
The survey of more than 300 doctors was prompted by the case of Miss B, who was fighting for the right to have the ventilator that has been keeping her alive turned off by doctors.
The doctors treating Miss B said they would not be prepared to switch the machine off because it went against their professional ethics. However, the High Court ruled last Friday that doctors did not have the right to refuse that request.
The survey findings show that doctors overwhelmingly agree that patients who are considered competent to make informed decisions have the right to refuse life-sustaining treatment.
Yet when asked whether they would personally be prepared to end a patient's treatment, knowing that it would kill them, only 61% said yes, while 28% said no, and 11% said they did not know.
The survey found that 49% of those polled agreed that the courts should decide which patients are capable of making a decision on whether they want to continue life-sustaining treatment, 38% said the courts should not decide, and 13% said they didn't know.
Preston general practitioner (GP) Margaret Lupton told the magazine, "Any doctor who did this without going through the courts would probably be accused of murder because of the perceived similarities between withholding treatment and euthanasia."
Another GP, David Holland of Derbyshire said, "Having the court as a final arbiter would protect those actually commissioning the fatal act from accusations of acting as another Harold Shipman"--a family doctor who was found guilty of killing elderly patients.
Although the High Court ruling was described as a landmark decision in the media, the BMA insists it simply upholds existing ethical guidance about the right of patients to refuse treatment.
"To impose treatment on a competent patient against their will is an assault and is against the law," Swindon consultant rheumatologist David Collins told the magazine.
However, Leeds consultant in old-age psychiatry, John Wattis, cautioned that there should probably be a required period of waiting to enable people to be completely settled in their mind.
Bedford consultant in anaesthesia and intensive care David Niblett said he would be prepared to end treatment only after much discussion. "Such decisions must always be made after careful consideration and multidisciplinary discussion by the critical care team," he explained.
"The doctor in charge of a patient should withdraw treatment when there is no continuing benefit," stated Manchester consultant anaesthetist Dev Rittoo. "Personal or religious beliefs should not disadvantage the patient. A team of carers is essential in the decision-making process. The doctor does not have to personally withdraw treatment."
According to consultant haematologist David Ellis from Greenock, Scotland, "If a patient refuses treatment, I don't think it is legal to continue. Thus in my own practice I do not continue with chemotherapy or transfusion if a patient refuses them."
However, he added, "Although I would not be caring for a patient like
Miss B, I do not think I could turn off a ventilator for a conscious patient."
Copyright © 2002 Reuters Limited