Doctors told to withdraw `useless' care

DOCTORS SHOULD stop providing treatment to patients to whom it is providing no benefit and allow them to die, even when the patients request the treatment, the British Medical Association said yesterday.

No one has an inalienable right to receive all possible treatment to keep them alive and doctors must be clear that the treatment they provide is likely to produce clinical benefit. In some cases, where the treatment is expensive, it may be withheld on cost grounds.

The association has drawn up the first ethical guidelines on withdrawal of treatment, published yesterday, in response to demands from doctors confused about their ethical and legal duty. But the advice drew condemnation from anti-euthanasia groups who accused the BMA of issuing doctors with a licence to kill.

Dr Michael Wilks, chairman of the BMA's ethics committee, said the guidance was needed because of growing confusion among doctors following the Tony Bland case, the Hillsborough victim who was left brain damaged, and advances in medical technology which have made it possible to prolong life indefinitely. "This is not about euthanasia. It is about asking a central question whether treatment is providing benefit. If the answer is maybe not, then the question is what steps should be taken in making a judgement whether to withhold or withdraw treatment. That is a long way from intentionally ending life. It is about a compassionate decision whether to provide treatment."

The guidance builds on the 1993 case of Mr Bland, who was left brain damaged and in a persistent vegetative state following the Hillsborough football stadium disaster. The Law Lords, in a landmark decision, agreed that artificial nutrition and hydration counted as a medical treatment and could be withdrawn, allowing him to die.

Last year, the association consulted 2,000 doctors on the issue and found widespread confusion about the implications of the case for patients with different conditions but in a similar state. Its guidance, the most comprehensive that has been assembled, covering adults and children and both competent and incompetent patients, says doctors should make every effort to reach agreement with patients and their families and other members of the health care team on what is in the best interests of the patient.

The guidance states that patients have a right to refuse treatment which cannot be over-ruled, even where there is clear evidence that it would be of benefit. But patients or their relatives do not have a right to demand treatment in the absence of evidence of benefit.

A group of lawyers and healthcare professionals called Hope (Healthcare Opposed to Euthanasia) said there was a need to recognise the inevitability of death but warned the guidance would be bad for some patients.

Dr Andrew Fergusson, chairman, said: "I am deeply concerned some doctors might interpret the guidelines to increase the number of unnatural deaths. I am anxious about even more powers being given to doctors in the absence of adequate safeguards."