The guidelines issued today by the Institute of Medical Ethics, an international think-tank, are a departure from its previous advice which said euthanasia was 'not in the public interest'.
However, while the institute's paper is a contribution to the debate, it does not alter ethical guidelines issued by the General Medical Council and the British Medical Association which maintain that doctors should not take action that shortens life.
Several controversial areas have been tackled in the paper, Developing Guidelines for Decisions to Forgo Life-Prolonging Medical Treatment, which is the result of a conference in May last year.
One significant shift in position from the earlier guidelines published in 1989, known as the Appleton Consensus, is the recognition that the growing scarcity of resources as more costly treatments become available will inevitably require decisions as to which patients receive treatment.
Justice demands that all patients should have equal access to treatment and that it should not be dispensed on morally irrelevant grounds such as 'race, religion or gender', or the ability to pay.
However, when deciding whether to treat patients with similar needs, the 'opportunity-cost' is now deemed an appropriate criterion. 'Scarcity of resources may sometimes require overriding a patient's request for life-prolonging treatment,' it says.
Also controversial is the guideline that patients in a Persistent Vegetative State - who display wake-sleep patterns but no evidence of thought - should be allowed to die. Tony Bland, the Liverpool soccer fan resuscitated after the Hillsborough disaster, is a case in point. His parents have been fighting in the courts for the right to allow him to die. 'The patient who is reliably diagnosed as being a PVS has no self-regarding interests. Consequently . . . there is no patient-based reason to continue life-sustaining treatments, including hydration and nutrition,' the paper says.
'It is unkind to allow unrealistic optimism to be sustained and it is unfair to allow the prolonged consumption of societal resources in support of such patients beyond a period of education and adjustment for the family.'
But those patients who cannot make decisions must be kept alive.
In the case of patients with incurable diseases who have decision-making capacity and request to die, it says: 'Such requests for active termination of life by a medical act which directly and intentionally causes death may be morally justifiable and should be given serious consideration.'
But doctors confronted with such pleas must examine the circumstances and seek alternative courses of action that might alter the patient's viewpoint.
John Stanley, the paper's author, said: 'The revised guidelines are more precise, and attempt to provide a firmer framework to help doctors and others making these decisions to balance the ethical demands of patient autonomy and a doctor's commitment to benefit his or her patients with the ethical demands of justice and efficiency in allocating scarce resources.'Reuse content