Guidance for witholding treatment

Guidance for doctors on the implications of withholding treatment from patients has been issued by the British Medical Association (BMA).

The Mental Capacity Act, part of which comes into force on Sunday, and the effects of cases such as those involving Leslie Burke and Charlotte Wyatt inform the guide.

A change in the law means a patient's rights to make advanced decisions about their treatment will now be recognised, including in the form of "living wills" and from October, patients can also appoint somebody to make decisions for them should illness render them incapable of making their own.

The third edition of the guide sets out how such changes could prevent difficult decisions for doctors, although it is not designed to give definitive legal advice.

It refers to a doctor's "duty of care" which states a patient must be kept alive using reasonable means when that is his or her wish. The only exception would be if a patient lacked mental capacity and it was not in their best interests to be kept alive artificially.

Where a patient lacks capacity and has not made an advance decision on their treatment, they should be kept alive unless it is not in their best interests, the guide says.

It also emphasises that doctors must make decisions based on how effective and useful a treatment may be, not on their own views of what a patient's life is worth and reminds doctors that treating adults against their will could create harm and may "be viewed by the courts as infringing their basic rights and possibly a criminal offence".

The guide sets out how, when a patient's representative and the doctors disagree, a Court of Protection may make a declaration or appoint somebody to make decisions on the patient's behalf.

It also says that patients who have requested continuing treatment in advance should have their wishes taken seriously "but there is no obligation to comply with such requests".

Dr Vivienne Nathanson, head of science and ethics at the BMA, said: "Our guidance does not provide ready-made answers and difficult decisions still need to be made, but we hope it will provide a framework that is helpful for doctors, patients and their families."

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