The Law, Patients and Health Care Professionals

The life span of human beings has been considerably enhanced, on account of the far reaching developments in science and medical technology. In such an environment, it is paradoxical to hasten the death of a patient. However, the fact remains that it is inhumane to deny a person to die with dignity. Despite making unprecedented advances, medical science has failed to improve human dignity, quality of life and personal control. There is a rapidly growing perception that people have the right to determine the time and manner of their death.

The extant legislation and case law seems to be headed towards extending support for such contention, hence, it is essential for health care providers to take cognisance of these developments (Euthanasia and Nursing Practice — Right Question, Wrong Answer, 1996). In some cases, voluntary physician assisted suicide is ethically acceptable. For instance, in some incurable diseases, the patient has to undergo extreme suffering and pain. In such situations, the patient must be allowed to exercise the right to self determination, in order to decide whether to live in pain or end life and die with dignity.

However, such requests must be carefully scrutinised to prevent the indiscriminate use of assisted suicide or euthanasia (Regulating Physican-Assisted Death, 1994). The United Kingdom and several other countries have permitted the withdrawal of tube – feeding, if the patient is diagnosed as being in a Persistent Vegetative State or PVS. This PVS state is the same as severe brain damage. Such withdrawal of tube feeding from a patient would be tantamount to euthanasia, if the aim is to bring about the death of the patient. Tube-feeding becomes ineffectual if the patient is unable to receive nourishment (Euthanasia briefing).

The objective of providing food and water is to sustain life; hence, the withdrawal of tube – feeding, for reasons of patient disability, is unwarranted. Therefore, the argument that tube – feeding does not cure illnesses and withdrawal of it would be just is unacceptable. Therefore, denying such tube-feeding on grounds of a patient’s disability is unjust and unethical (Euthanasia briefing). Advance directives are instructions to doctors from patients to discontinue life supporting measures, if the latter develop paralysis, incontinence or the inability to communicate.

Such advance directives, clearly indicate whether the treatment is to be continued or stopped even if the outcome of such instructions were to be fatal (Euthanasia briefing). Albeit, advance directives are not requests for euthanasia, it is possible to interpret them as instructions to discontinue tube-feeding. Therefore, advance directives have been termed as the living will of patients. The supporters of euthanasia have demanded that such living wills are to be respected, because they allow patients to die with dignity.

Therefore, the opponents of euthanasia have vehemently opposed any move to enact legislation that would legitimatise living wills (Euthanasia briefing). Under these new Labour Government guidelines, doctors are required to respect the advanced directives of their patients, meticulously. These advance directives can include requests for withholding of medical treatment, even if such cessation results in the death of the patient. The English courts have ruled in some cases that withdrawal of feeding and hydration tubes would be in the best interests of the patient, even though it would lead to the patient’s death.

In many countries, food and hydration are considered as part and parcel of medical treatment. In the year 2005, a Canadian court allowed the killing of Terri Schindler Schiavo on these grounds (UK doctors face jail if they refuse to euthanize patients, 2006). In the UK, Leslie Burke challenged the guidelines of the General Medical Council that permitted doctors to withhold tube – feeding. He was suffering from a degenerative nervous system disorder, which compelled him to use a wheelchair. Burke feared that his condition became so bad that he could no longer swallow or communicate, the doctors would withhold life saving tube-feeding.

The court accepted his argument and directed the General Medical Council to review its guidelines, so as to compel doctors to provide tube-feeding and hydration to competent patients upon request. In the case of incompetent patients, the doctors were to provide such treatment; if there was an advance directive from them to that effect (Dutch euthanasia law exists to protect doctors, not patients , 2005). A 12 year old boy’s life was put to risk, when doctors incorporated a Do Not Resuscitate order in his medical records.

The protests of the boy’s mother were ignored. The English Courts did not intervene and it was upto the European Court of Human Rights, which heard this case, to rule unanimously that the doctors had violated the human rights of the boy and his mother (Dyer, March 20, 2004). The ECtHR held that the hospital and the doctors had intentionally violated the human rights of David and the right to respect for his private life. They had also breached David’s right to physical integrity as laid down by the Article 8 of the ECHR (International TaskForce. org, 2004).

In Bland, the House of Lords held that the doctors were under no duty to continue tube-feeding. Their Lordships gave this ruling, in order to enable the doctors to withdraw treatment in the best interests of the patient (Airedale NHS Trust v Bland). The opinion of a responsible medical body is to be obtained, in order to deem treatment as futile. Specifically, doctors had to fulfil the conditions stipulated in the Bolam test, which relates to medical negligence (Keown, Euthanasia, Ethics and Public Policy: An Argument Against Legislation, 2002, P.

219). In the year 1995, the Irish Supreme Court permitted doctors to discontinue tube-feeding to a patient who was not in Persistent Vegetation State or PVS. The patient had displayed some cognitive functions, and the judges opined that such patients felt greater suffering than those in a PVS. This judgment demonstrated the arbitrary nature of decision, with regard to the quality of life judgements (Keown, Ethics and Public Policy : An Argument Against Legalisation, 2002, P. 226).

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