Wednesday, September 20, 2017

Complexities of 'end of life' care

BBC is reporting today on an important legal case where Mr Justice Jackson has ruled that where relatives and clinicians treating patients in a permanent vegetative state agree that care can be ended, there should be no need for a judge to agree as well. Until now, all treatment, except withdrawal of food and fluid can be ended without a judge's involvement. A judge's involvement means incurring  great unnecessary expense. However, the implications of this judgement are such that the Official Solicitor may well appeal in the interests of clarifying the law.
This is a sensitive and difficult policy area, morally, legally and from the perspective of patient safety. A few years ago, I made public comment disagreeing with a judge who had ruled that a patient suffering from anorexia, with only a minuscule chance of living should be force fed. The case attracted a lot of publicity, as did my comment, which I had intended only to stimulate discussion. It was a policy area of interest to me, being opposed to the legalisation of assisted suicide - itself not a straightforward issue. The Justice Jackson case is not the same, but raises equally difficult questions in the field of end of life.
In this case, and at this stage, I rather agree with the judge. But I do feel the need to discuss it with others before coming to a final conclusion. Relatives and clinicians can already take actions such as withdrawing Dialysis, which results in death, without the involvement of a judge. I cannot see why this principle cannot be extended withdrawal of food and fluids. The only issue of concern to me is that it only applies in cases where the patient is in a permanent vegetative state and has miniscule chance of recovery.

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