The BMA is launching updated guidance on withholding and withdrawing life-prolonging treatment, to take into account the major changes for patients and doctors that will come into force when the Mental Capacity Act is implemented in England and Wales in April and October 2007.
Chairman of the BMA?s Ethics Committee, Dr Tony Calland, said:
?These are major changes and it is extremely important that doctors and patients are made aware of them. This new legislation will empower patients. From October 2007 patients will have the right to nominate a welfare attorney to act on their behalf when they can no longer communicate their wishes to health professionals. In addition, from April in England and October in Wales, where a patient lacks capacity and does not have any family or friends, an Independent Mental Capacity Advocate (IMCA) must be involved with making serious medical decisions. The Act also puts advance decisions about medical treatment onto a statutory footing for the first time.?
The third edition of ?Withholding and Withdrawing Life-prolonging Medical Treatment ? Guidance for decision making?, produced by the BMA?s Medical Ethics Committee [MEC], incorporates guidance on the Mental Capacity Act and also on the implications of court judgments in recent legal cases such as those of Leslie Burke, Charlotte Wyatt and others. It also emphasises that good quality care, including the offer of oral nutrition and hydration and alleviation of symptoms, and steps to ensure the dignity of the patient, must always be provided.
The guidance covers issues such as how to assess capacity and the patient?s best interests, providing basic care, decision making on behalf of adults, young people, children and babies and by those who have made an advance decision about medical treatment. Legal variations in all the devolved countries are covered.
Dr Calland explained that: ?A decision to withhold or withdraw life-prolonging treatment is extremely difficult for patients, families and doctors but can be an important part of good medical care. The primary goal of medicine is to benefit patients and if medical treatment can no longer do this then, ethically and legally, doctors must consider whether it should be withdrawn.
?It is essential that patients, their carers and families are assured that carefully thought through guidance exists to help doctors in this complex process. Decisions need to be made on an individual basis, assessing the particular circumstances, wishes and values of the patient to ensure that treatment is neither withdrawn too quickly nor unnecessarily prolonged.
?Communication and consultation between doctors, patients and families are vital so that they can work together to reach a decision that is right for each individual patient. This process is much easier for everyone if patients have given some thought to what they would want, or to the things that are important to them, and have made their views known. That is why we welcome this legislation, which provides formal mechanisms for these wishes to be heard. Where, for example, patients have clear views about the level of recovery they would find acceptable or about the stage at which active treatment aimed at prolonging their life should be stopped, these views can either be recorded in a written advance decision or they can be made known to an appointed welfare attorney, who will be consulted about health care decisions.?