Doctors condemn feeding guidelines

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The Independent Online
DOCTORS LINKED to religious organisations yesterday declared controversial guidelines on the withdrawal of treatment for incapacitated patients a "death ethic".

The Guild of Catholic Doctors and the Health Division of the Muslim Council of Britain said the withdrawal of food and drink even when artificially provided by tube was "inhumane" and could never be justified. The Chief Rabbi Jonathan Sacks and the Roman Catholic Archbishop of Glasgow, Cardinal Thomas Winning, supported them and expressed regret at the guidelines.

The doctors are planning to mount a protest at the British Medical Association's annual conference in Belfast today when the issue is to be debated. They have been angered at the BMA's decision to define artificial nutrition and hydration, in which food and fluids are delivered direct by tube to the stomach, as a form of treatment that may be withdrawn.

The guidelines, issued by the BMA last month, say that where treatment is providing no benefit to seriously ill patients with no prospect of recovery it may be right to withdraw it to avoid prolonging suffering.

Dr Anthony Cole, a consultant paediatrician and a member of the Guild of Catholic Doctors, said: "This applies to people who are suffering from common conditions such as stroke and dementia and who may live months or years. It improperly equates treatment by tube with obvious medical treatments like ventilation and chemotherapy." He added: "If it were carried out it would lead to a slow and inhumane death. We hold most strongly that death by deliberate starvation or dehydration is illegitimate and unacceptable."

Dr Cole said he was not opposed to withdrawing treatment, such as by turning off a ventilator. "We are not vitalists, we are not about preserving life at any cost."

The BMA guidelines distinguish between tube feeding, which is defined as a treatment and may be withdrawn and feeding by spoon or cup which is basic care and may never be withdrawn. The guidelines build on the 1993 case of Tony Bland, who was left in a persistent vegetative state following the Hillsborough football 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in a landmark decision agreed that artificial nutrition and hydration counted as a medical treatment and could be withdrawn, allowing him to die.

Dr Michael Wilks, chairman of the BMA Ethics Committee, said: "I would ask those who believe nutrition and hydration should never be withdrawn to consider that the consequences will be that burdensome treatment will be continued long beyond the point where it would be of benefit and I don't believe that's compassionate medicine."

t The ITV series Peak Practice was attacked for lack of realism at the conference by GP Dr Chaand Nagpaul. He said: "Te patient does not need to request a home visit, but the GP instead readily offers to pop in during those spare hours in the day, for that living room consultation over a fresh cuppa." Dr Nagpaul won backing for his motion calling for the regulation of medical dramas.