Withholding Life Sustaining Treatment - Essay Example

Withholding life sustaining treatment In a landmark medical decision, a nineteen month old child known as Baby M, with a severe medical condition was being kept alive on a ventilator and the High Court ruled that doctors could not switch off the ventilator keeping it alive (BBC News Report, 2006). This case has highlighted the ethical issues surrounding the question of life sustaining treatment, especially in the case of patients who are not able to express their autonomy in medical decision making, such as babies and mentally incapacitated individuals. Commenting upon the decision in the Baby M case, the Royal College of Paediatrics and Child Health observed that the judgment was in accordance with the guidelines it had set out in 2004 in consultation with parents, patient groups and representatives of different religious groups.(BBC News Report, 2006). It expressed the opinion that each case was to be treated individually and rigid rules could not be imposed that would apply in every case. But as discussed below, the precedents established by the Courts have shown that in general, the guiding principle is one of favouring life although each case is considered on its own merit. The Charlotte Wyatt case1 concerned a prematurely born baby that was suffering from a number of life threatening conditions. The Court also held in this instance that life sustaining treatment to the child could not be withdrawn. The Children Act of 1989 requires that the welfare of the child be accorded top priority and this is the guiding principle in all decisions that are made in reference to children. This is also the basis whereby the Crown can intervene in order to ensure that the interests of children are protected, because they are in effect disabled to the extent that they cannot look out for their own interests. As a result, decisions to be made about their treatment may also be taken by courts, especially when a patient has entered a persistent vegetative state (PVS). The decision of the House of Lords in Airedale NHS trust v Bland2 also held that when a patient has entered the PVS stage, then it may be lawful for the Courts to order the withdrawal of life sustaining treatment because this would be in the best interests of the patient. It would also be lawful to withhold treatment in such cases because it would be in the patient’s best interests to be allowed to die with dignity3. Where adults are concerned, the question of how far a Court can step in to make decisions about the treatment options or welfare of an incapacitated or disabled person were at issue in the case of Re F4. In this case, the issue was whether sterilization would be in the best interests of a 36 year old, handicapped woman. The medical decision taken in this case to sterilize the patient was also affirmed by the Court. The House of Lords held that although the autonomy of the patient had been overridden, the Courts have an inherent jurisdiction to make decisions about the lawfulness of withholding life sustaining treatment when it would be in the patient’s best interests. Similarly, in Airedale NHS Trust v Bland, the Court also held that in the case of a vegetative patient who was being provided with artificial life support, it was lawful to withdraw this support being provided by artificial means. The justification for these decisions was (a) any treatment proposed by a doctor was likely to be in a patient’s best interests, despite the absence of the patient’s consent, and the principle of necessity made it lawful for a doctor to administer such treatment (b) courts have the power to determine whether or not a patient is competent to make a decision about treatment and (c) the jurisdiction of the Court is based upon the best interests of the patient and not upon the doctrine of substituted judgment of what the patient would have wanted if he or she had been capable of making a decision. The rationale behind the decision in Airedale has also been held to be perfectly compatible with the right to life under Article 2 of the European Convention of Human Rights, as also laid out in the case of Pretty v UK5. The precedents in the above cases show that the driving factor behind such decisions is likely to be the patient’s best interests. The case of Re F (1990) has established that the High Court has inherent jurisdiction to make decisions on behalf of patients who are unable to take those decisions themselves. In the case of Baby M, it may be noted that this was also the basis for the decision of the Court. The lawfulness of the Court exercising jurisdiction was already established in the earlier cases and in the case of Baby M, the decision of the Court to refuse the doctors to withdraw life sustaining treatment was also in accordance with what the Court perceived to be the patient’s best interests. It is the best interests of the patient that have become the overriding factor that governs the decisions of the courts and withdrawal of life sustaining treatment has only been allowed in those cases where it is considered to be in the patient’s best interests. The criterion of best interests of the patient was recently questioned on the basis of the lawfulness of the guidelines issued by the General Medical Council, from the perspective of whether or not it would provide adequate protection to patients and not deprive them of the life sustaining treatment that they needed. In Burke v GMC6, which was a judicial review of the guidelines, Mumby J of the Court of Appeal expressed the opinion of the Court. It was held that while the right of the patient to receive life sustaining treatment and be kept alive is not absolute, it is akin to a general rule where the only exceptions that could be allowed to override are (a) when the patient refuses the treatment and (b) when it is not in the patient’s best interests to be kept alive artificially. Applying this in the case of Baby M, it may be noted that the patient was too young in this instance to refuse treatment and since it could not be conclusively established that it was in the patient’s best interests to be kept alive artificially, the Court ruled that doctors could not stop the life sustaining treatment. In an analysis of developments in treatment options for patients who are on life sustaining treatment, Oates expresses the view that the jurisdiction of the Court sis more about preserving life and ensuring that doctors are in a position to take active steps in doing whatever is medically necessary to ensure that the life of the patient is prolonged7. The preferred alternative that the Courts are likely to follow is therefore one of continuation of life. The case of Burke in particular has applied the criterion that life needs to be respected, but it is the touchstone of “best interests” that must be the guiding criterion. It is only in those cases where it would be intolerable from the perspective of the patient to continue treatment, that it would be considered an acceptable option to discontinue treatment. In conclusion, it may thus be stated that from an ethical standpoint, it is morally right to sustain life rather than to end it by withholding life sustaining treatment. This has generally been the guiding principle upon which Courts have handed down their decisions. At the outset, each individual case is assessed on a case by case basis and there is no hard and fast rule that would apply in all cases. But on an overall basis, the guiding principle of the Courts has been to preserve life and therefore preserve life sustaining treatment, unless (a) it has been clinically established to be in the best interests of the patient to end the life with dignity or (b) it would be intolerable from the patient’s perspective to continue with the treatment. This principle of the Courts and the decisions rendered in this regard reflect the underlying belief that the State as represented through the Courts, is responsible for protecting the interests of those who are unable to protect it for themselves. References: BBC News Report, 2006. “Reaction to right-to-life ruling”, http://news.bbc.co.uk/1/hi/health/4809614.stm; Oates, Laurence, 2007. “Life, death and the Law”, Common Law World Review 36 1(1). Cases cited: Airedale NHS Trust v Bland [1993] AC 789 Burke v GMC [2005] EWCA 1003 Pretty v UK [2002] 35 EHRR 1 Re: F [1990] 2 AC 1 Wyatt v Portsmouth Hospital NHS Trust and Charlotte Wyatt [2005] EWCA Civ 1181, [2005] 1 FLR 21 Read More