British Medical Association proposes death by dehydration
BMA Guidelines on curtailing life
United Kingdom (1999)
We welcome and share the concerns expressed by
your reports (June 24) about the guidance on the
withdrawal and withholding of treatment issued by a
committee of the British Medical Association (BMA).
We do not consider the guidance to be ethically
acceptable as a whole, and parts do not even appear
to reflect the current state of the law. In fact,
the document effectively calls for a change in the
law, particularly in relation to the requirement to
seek a court order before withdrawing nutrition and
hydration by tube.
Instead, the authors of the document wish to
allow doctors to seek a second opinion in order to
authorise the withdrawal of food and fluids in cases
such as those involving stroke patients or the
confused elderly, even when the patient is not
terminally ill. Moreover, the guidance claims for
doctors the right to overrule the wishes of the
patient's family in this matter.
We recognise the need to avoid the unnecessary
prolongation of useless or burdensome treatment and,
insofar as the guidance recognises the sensitivity
of these decisions and endeavours to put in place an
open and professional framework, it is to be
However, we believe that most people do not
accept that the provision of food and water to
patients is ordinarily anything less than basic
nursing care. It is not medical treatment that can
simply be denied to a patient who is not dying.
Withdrawal of fluids will cause the patient to
die from dehydration, which is distressing to the
patient, to the carers and to relatives. It is
disingenuous and inhumane to suggest the contrary.
The effect upon healthcare workers' morale will
also be damaging. The document's suggestion that
food and fluids be withdrawn on the recommendation
of a senior clinician means, following the decision
in the case of Tony Bland, the Hillsborough victim,
that withdrawal of fluids would then be obligatory
for the medical staff as the patient would no longer
have a right to such sustenance.
It would follow that doctors or nurses who
refused to bring about death by dehydration might
then be penalised or even dismissed.
It is most regrettable that the guidance has been
published only a few days before the annual
representative meeting of the BMA, so that it has
not been properly debated by the BMA membership.
PHILIP HOWARD, Consultant gastro-enterologist,
PETER DOHERTY, General practitioner,
ANDREW FERGUSSON, General practitioner,
JAMES BOGLE, Barrister,
GERARD WRIGHT, QC, barrister, A. P. COLE, Consultant
ADRIAN TRELOAR, Consultant
geriatrician/psychiatrist, c/o St George's Hospital,
Blackshaw Road, Tooting, SW17 OQT.
* The newspaper does not wish
to be identified