British Medical Association proposes death by dehydration

Sir,

We welcome and share the concerns expressed by your reports (June 24) about the guidance on the withdrawal and withholding of treatment issued by a committee of the British Medical Association (BMA).

We do not consider the guidance to be ethically acceptable as a whole, and parts do not even appear to reflect the current state of the law. In fact, the document effectively calls for a change in the law, particularly in relation to the requirement to seek a court order before withdrawing nutrition and hydration by tube.

Instead, the authors of the document wish to allow doctors to seek a second opinion in order to authorise the withdrawal of food and fluids in cases such as those involving stroke patients or the confused elderly, even when the patient is not terminally ill. Moreover, the guidance claims for doctors the right to overrule the wishes of the patient's family in this matter.

We recognise the need to avoid the unnecessary prolongation of useless or burdensome treatment and, insofar as the guidance recognises the sensitivity of these decisions and endeavours to put in place an open and professional framework, it is to be welcomed.

However, we believe that most people do not accept that the provision of food and water to patients is ordinarily anything less than basic nursing care. It is not medical treatment that can simply be denied to a patient who is not dying.

Withdrawal of fluids will cause the patient to die from dehydration, which is distressing to the patient, to the carers and to relatives. It is disingenuous and inhumane to suggest the contrary.

The effect upon healthcare workers' morale will also be damaging. The document's suggestion that food and fluids be withdrawn on the recommendation of a senior clinician means, following the decision in the case of Tony Bland, the Hillsborough victim, that withdrawal of fluids would then be obligatory for the medical staff as the patient would no longer have a right to such sustenance.

It would follow that doctors or nurses who refused to bring about death by dehydration might then be penalised or even dismissed.

It is most regrettable that the guidance has been published only a few days before the annual representative meeting of the BMA, so that it has not been properly debated by the BMA membership.

Yours sincerely,

PHILIP HOWARD, Consultant gastro-enterologist,
PETER DOHERTY, General practitioner,
ANDREW FERGUSSON, General practitioner,
JAMES BOGLE, Barrister,
GERARD WRIGHT, QC, barrister, A. P. COLE, Consultant paediatrician,
ADRIAN TRELOAR, Consultant geriatrician/psychiatrist, c/o St George's Hospital, Blackshaw Road, Tooting, SW17 OQT.

* The newspaper does not wish to be identified