This article appears in the February 2000 edition of the Catholic Medical Quarterly

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BMA’s ethical guidance ‘muddle’

From Mr James Bogle and Dr Philip J. Howard
The Times 21 Dec. 1999


Dr Michael Wilks, chairman of the Medical Ethics Committee of the BMA, has recently written in the context of the furore over the treatment of the elderly in the NHS that it would be appalling if people believed that the BMA’s new ethical guidance on the withdrawal of treatment could be interpreted as permission to starve patients to death.

In fact, if one looks at the guidance itself (produced by Dr Wilks and his committee) one sees written:
the main focus of this guidance is decisions to withdraw or withhold life_prolonging treatment from patients who are likely to live for weeks, months or possibly years if treatment is provided but who, without treatment, will or may die earlier. In some areas mention is also made of treatment decisions for those patients whose imminent death is inevitable (para 2.1, page 4).

Hence, it is clear that the guidance is aimed at least as much at those who are not dying as at those who are. The guidance also says: life_prolonging treatment.. . includes artificial nutrition and hydration (para 3.1, page 6).

It adds: it is recognised that neither the nutrition nor the hydration is, in fact, artificial although the method for delivering it is (para 3.4. page 7).

It is plain, therefore, that Dr Wilks and his committee envisage that food and fluids could be with drawn or withheld from some patients if delivered by tube. Without food and fluids the patient will inevitably die of dehydration or starvation. Thus, there is an inherent contradiction between what the guidance says and what its authors think it says. This is part of the muddle at the heart of the ethical debate over care of the elderly and incapacitated.

The solution offered by the guidance for those doctors and nurses who might object to dehydrating their patients to death is, wherever possible, [to] be permitted to hand over care of the patient to a colleague (para 24.1, page 62).

But why should doctors be asked to relinquish care of their patients because they refuse to dehydrate them to death? Why should the judgment of the conscientious doctor be so overridden? Why should patients be delivered into the hands of doctors who intend to cause their death? It is worth noting that the guidance is merely advisory. The BMA cannot supplant the role of Parliament and the courts in making and interpreting the law.


Yours sincerely,

JAMES BOGLE (Barrister),
PHILIP J. HOWARD (Consultant Physician),

c/o 10 Kings Bench Walk, EC4Y 7EB

December 20.

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