Withholding and Withdrawing Life-prolonging Medical Treatment (eBook)

This book is written and edited by members of the Medical Ethics Department of the British Medical Association with advice from the BMA's Medical Ethics Committee. The British Medical Association is the professional association and registered trade union for doctors in the United Kingdom. The association does not regulate or certify doctors, a responsibility which lies with the General Medical Council.

Medical Ethics Committee viii

Editorial board for the third edition x

Acknowledgements for the third edition xi

Introduction xii

Part 1: How to use this guidance 1

1. Scope, purpose and structure of this guidance 1

Part 2: Defining key terms and concepts 3

2. The primary goal of medicine 3

3. Life-prolonging treatment 5

4. Capacity and incapacity 5

5. Duty of care 6

6. Quality of life 8

7. Benefit 10

8. Harm 11

9. Best interests 12

10. Futility 14

11. Basic care 15

12. Artificial nutrition and hydration 15

13. Oral nutrition and hydration 17

14. Foresight and intention 18

15. Withholding or withdrawing treatment 19

16. Conscientious objection 20

17. Resource management 21

Part 3: Legal and ethical considerations that apply to all
decisions to withhold or withdraw treatment 23

18. Human Rights Act 1998 23

19. Fairness and non-discrimination 28

20. Communication 31

21. Confidentiality 32

22. Legal review 34

Part 4: Medical considerations that apply to all decisions to
withhold or withdraw treatment 36

23. Medical assessment 36

24. Medical decision making 39

Part 5: Decision making by adults with capacity 43

25. The law 43

26. Communication and information 47

Part 6: Decision making on behalf of adults who lack capacity
50

England and Wales 50

27. Patients with a Lasting Power of Attorney (LPA) 50

28. Patients with an advance decision about medical treatment
52

29. Patients without a Lasting Power of Attorney or advance
decision 57

30. Patients in persistent vegetative state (pvs) 61 Scotland
62

31. Patients with a welfare power of attorney or welfare
guardian 62

32. Patients with an advance decision about medical treatment
64

33. Patients without a welfare power of attorney or advance
decision 67

34. Patients in persistent vegetative state (pvs) 68

Northern Ireland 69

35. Patients with an advance decision about medical treatment
69

36. Patients without an advance decision about medical treatment
69

37. Patients in persistent vegetative state (pvs) 71

All UK jurisdictions 72

38. Capacity and incapacity 72

39. Communication and information 73

40. Assessing best interests 77

41. Dealing with disagreement 80

Part 7: Decision making by young people with capacity
83

42. The law in England,Wales and Northern Ireland 83

43. The law in Scotland 88

44. Assessing capacity 91

45. Communicating with young people 92

46. Dealing with disagreement 95

Part 8: Decision making for children and young people who
lack capacity 96

47. The law 96

48. Duties owed to babies and children 102

49. Communicating with parents 104

50. Assessing best interests 106

51. Dealing with disagreement 108

Part 9: Once a decision has been reached 109

52. Keeping others informed 109

53. Recording and reviewing the decision 109

54. Providing support 111

55. Respecting patients' wishes after death 113

Appendix 1 Useful addresses 114

References 118

Index 123

"Should become obligatory reading for any ethicist, politician or
jurist who focuses on end-of-life decision making."

Medicine, Health Care, and Philosophy, 2008

"The report bears three intriguing strengths: (1) The ethical
argumentation is impressively clear, consistent and convincing...
(2) The ethical argumentation is backed up by constant references
to recent legal cases and decisions and to the latest legislation.
(3) The structure of the book is highly transparent, the style is
clearly written and easy to read, and throughout the whole book the
reader is spoiled with precise summaries of the main arguments and
theses. Due to these strengths, the BMA guidance paper not only
provides a comprehensive overview of the legal position in
Scotland, England, Wales, and Northern Ireland and advances the
debate by clear ethical arguments in those areas that are not
addressed by the present law. It also serves as a role model for
other European countries which seem to fall far behind such an
elaborated position paper and where doctors still muddle through
the complexity of end-of-life decision-making in everyday clinical
life...

... The BMA report should become an obligatory reading for any
ethicist, politician or jurist who focuses on end-of-life decision
making and serves as a helpful guidance for any doctor concerned
with decisions about life-prolonging treatments in clinical life" -
Matthis Synofzik, Tubingen, Germany, Med Health Care and Philos
(2007)