UK Court rules the incapacitated can be starved

[Seagoon]

A while back we were discussing the case of Terri Schiavo, a woman who had not left instructions as to whether she wished to continue receiving food and water after she became incapcitated. Now, a UK appeals court has determined that a mailman does not have the right to continue receiving food and water after he becomes incapacitated, even though that is his express desire. In other words, the decision over whether the incapicitated live or die has been legally transferred from patients and even from their family to their "loving" doctors. It should be noted that were we suggesting starvation and dehydration as the standard method of executing convicted criminals it would instantly be dismissed as excessively cruel and inhuman.

We have created a medical community who consider feeding and hydrating the comatose "overly burdensome" and who consider death to be "therapeutic." Funny how 60 or so years ago, we executed doctors for engaging in the same kind of euthanasia program. As I've said before, perhaps we owe those doctors relatives an apology.

Terminally Ill Can Be Starved to Death, UK Court Rules
By Nicola Brent
August 02, 2005

An appeal court has denied a terminally ill British man the assurance that his wish not to be starved to death once he becomes incapacitated will be respected to the end.

Former mailman Leslie Burke, 45, has a progressively degenerative disease that although leaving him fully conscious, will eventually rob him of the ability to swallow and communicate.

He petitioned the High Court last year to ensure that he would not be denied food and water once he was no longer able to articulate his wishes.

Burke won that right when judge James Munby ruled that if a patient was mentally competent -- or if incapacitated, had made an advance request for treatment -- then doctors were bound to provide artificial nutrition or hydration (ANH).

But last May, the General Medical Council (GMC) -- the medical licensing authority -- took the case to the Appeal Court, arguing that doctors had been placed "in an impossibly difficult position."

The appeal judges have now agreed, overturning the High Court judgment and upholding GMC guidelines on how to treat incapacitated patients.

Those guidelines give doctors the final say in whether a patient should be given life-sustaining "treatment," a term legally defined to include artificial feeding or hydration.

The latest ruling obliges doctors to provide life-prolonging treatment if a terminally ill and mentally competent patient asks for it.

However, once a patient is no longer able to express his or her wishes or is mentally incapacitated, doctors can withdraw treatment, including ANH, if they consider it to be causing suffering or "overly burdensome."

Ultimately, the court said, a patient cannot demand treatment the doctor considers to be "adverse to the patient's clinical needs."

Anti-euthanasia campaigner and author Wesley Smith told Cybercast News Service it was important Burke had taken the case to court because "it is now clear that a patient who can communicate desires cannot have food and water withdrawn.

"That is a line in the sand that is helpful."

However, he added, the judgment had "cast aside" those who were mentally incompetent or unable to communicate their wishes -- "those who bioethicists call non-persons because of incompetence or incommunicability.

"I believe that the judgment clearly implies that the lives of the competent are worth more than the lives of the incompetent since doctors can decide to end life-sustaining medical care, including ANH," said Smith, a senior fellow at the Discovery Institute and author of Culture of Death: The Assault on Medical Ethics in America.

Burke was quoted as saying in reaction to the ruling that it held "no good news at all" for people who shared his concerns.

In the light of public health service cuts and underfunding, Burke said he was worried about "the decisions that will have to be made" by doctors in the future.

"I have come to realize that there are quite a few people who feel the same way I do," the Yorkshire Post quoted him as saying. "Not everyone wants to be put down. Not everyone wants their life to be ended prematurely."

Responding to the court's ruling, the GMC said it should reassure patients.

The council's guidelines made it clear "that patients should never be discriminated against on the grounds of disability," said GMC President Prof. Graeme Catto in a statement.

"We have always said that causing patients to die from starvation and dehydration is absolutely unacceptable practice and unlawful."

A professor of palliative medicine at Cardiff University, Baroness Ilora Finlay, supported the court ruling. "Stopping futile interventions allows natural death to occur peacefully," she argued in a British daily newspaper. "This is not euthanasia by the back door."

But the Disability Rights Commission (DRC) took a different view.

The commission was one of several campaigners, including right-to-life activists and patients' groups, which had strongly supported Munby's earlier ruling.

DRC Chairman Bert Massie expressed the group's dismay at the Appeal Court decision, saying it did nothing to dispel the fears of many disabled people that "some doctors make negative, stereotypical assumptions about their quality of life."

It had also "totally ignored" the rights of those who were unable to express their wishes, he added.

(CNSNews.com)

[Toad]

Well, if that's how it's going to be they should at least give all him the option of being "put down". Just because he can't communicate with them doesn't mean that starving him to death is the best way to end it.

You think they'll at least give him the courtesy and respect they'd give a 14 year old Labrador?

[Nash]

Unless you have the money to keep yourself or someone else alive indefinitely (it aint cheap), then that's the same as it is in Texas (and other states?)..... The doctors can and do just pull the plug.

I agree with Toad, though... Some kind of euthanasia would be preferable.

[Maverick]

It is a bit ironic given all the flap over Kavorkian's activities in dealing with folks who did not want to live in their condition.

[Toad]

Nash, what Texas law are you citing?

The only one I can find is the Advance Directives Act.

That lets a patient's surrogate make life-ending decisions on his or her behalf but also allows Texas hospitals to disconnect patients from life-sustaining systems if a physician, in consultation with a hospital bioethics committee, concludes that the patient's condition is hopeless.

Still, the authorized family members can seek extensions in court and then if the court challenges fail the hospitals could authorize the end of life.

That's not quite the same as what Seagoon has posted.

[Seagoon]

In this case the man, Leslie Burke, who suffers from cerebellar ataxia, a degenerative brain condition similar to MS, went to court to request that when he loses the ability to swallow and speak that he not be starved to death. To quote Burke:

"Not everyone wants to be put down. Not everyone wants their life to be ended prematurely."

Burke is not requesting expensive  treatment , or heroic lifesaving measures, he is simply asking that doctors be required to continue giving him the food and water that all human beings need to stay alive.

The court however ruled that a patient (or his relatives) cannot demand that a doctor administer a treatment which the doctor considers adverse to the patient's" clinical needs." In other words, if his doctors determine that the best course of treatment is for him to die of thirst, rather than being fed and hydrated through a tube, then the patient has no right to countermand that decision - in essence this would make a "living will" a meaningless scrap of paper.

So while Britain can spend millions of pounds making drugs like viagra and RU486 available to all, keeping the unrecoverably incapacitated fed is an undue burden and starvation may be the best therapy. Gents I cannot help thinking that we are becoming a thoroughly hedonistic culture of death which treats the weak and elderly as expendable and which only values human life according to its "potential productivity." The idea that human life is inherently valuable because it is created in the imago dei and that starving people to death against their will is evil, seems to have evaporated from our ethics.

What really is next? We already have eugenic abortion, and eugenic infanticide, we have embraced voluntary euthansia, and seem poised to embrace involuntary euthanasia. I can only wonder who will make up the next class of "useless eaters" who need to be eliminated?

- SEAGOON

[Nashwan]

So while Britain can spend millions of pounds making drugs like viagra and RU486 available to all, keeping the unrecoverably incapacitated fed is an undue burden and starvation may be the best therapy.

That's not actaully what the court ruled, though.

What the court said is that doctors cannot be made to give treatment they don't think is in a patient's best interest. The patient's best interest, not whoever's paying for the treatment.

In fact, the appeal court said that a doctor denying food and water a patient had previously asked for would be guilty of murder:

"For a doctor deliberately to interrupt life-prolonging treatment in the face of a competent patient's expressed wish to be kept alive, with the intention of thereby terminating the patient's life, would leave the doctor with no answer to a charge of murder"

Burke's solicitor said the same thing after the verdict:

"The Court of Appeal has confirmed that patients like Mr. Burke who want food and water have to be given it and that the failure to do so would constitute murder"

This case wasn't about starving Burke to death when he can no longer say he wants food, it was about an earlier court's ruling that meant doctors would have had to provide certain treatments the patient asked for, even if they were of no benefit, or harmful to the patient.

Again from the appeal court judgement:

"Ultimately, however, a patient cannot demand that a doctor administer a treatment which the doctor considers is adverse to the patient's clinical needs,"

[myelo]

Nobody is going to be starved. Once you unspin all the rhetoric, what Burke wanted to do was change the current guidelines and the court was worried such a precedent might be used to force doctors to administer other treatment that could cause distress.

But the court confirmed that patients like Burke who want to continue food and water will be given such treatment based on the current guidelines.

Lord Phillips, giving the ruling of the court, said: "Where a patient indicates his or her wish to be kept alive by the provision of artificial nutrition and hydration , any doctor who deliberately brings that patient’s life to an end by discontinuing the supply of ANH will not merely be in breach of duty but guilty of murder."

[Seagoon]

Hi Nashwan,

Respectfully, the case was still a monumental loss for a patient's right to life - and here I'm annotating from the BBC version of the story:
    
First: "Artificial nutrition" is classed as a form of treatment by the GMC.

Second: The ruling reaffirms that doctors in cases such as Burke's "have the ultimate say on what treatment to give a patient in the final stages."

Third: The statement regarding curtailing food and water being murder referred specifcally to "competent" patients. Burke's entire case hinged on the fact that he will eventually become "medically incompetent," but wished his desires to be made known in advance.

As Liz Sayce, of the Disability Rights Commission, put it: "The judgement is fine for people who have the capacity to speak. But the difficulty is when you don't have that capacity, it will be back to the doctor taking the decision entirely themselves."

In any event, the ruling leaves Doctors in ultimate control, terms food and water "treatment" and allows them final say so as to whether to continue treatment regardless of the patient's wishes. Under this ruling the decision to curtail "the treatment" of a terminally ill and incompetent patient is never going to be termed "murder" in the UK. All that is necessary is for the doctors to determine that such treatment is not beneficial. "We aren't going to murder anyone" is a reassuring noise made by people who wouldn't classify "suspending unhelpful or 'harmful' treatment" as murder. Your life or death is still at the whim of an increasingly utilitarian state system.

- SEAGOON

[Seagoon]

Originally posted by myelo
Nobody is going to be starved.

Myelo,

The grounds for bringing the suit did not develop in a vacuum. Just to give you one recent "For instance" from the Telegraph:
---------------------
Hospital 'starved 11 patients to death'
By Nick Britten
(Filed: 19/01/2005)

Eleven elderly patients on the same hospital ward were deliberately starved to death, an inquest was told yesterday.

The patients, all men aged between 67 and 93, died after having their food and drink needlessly withdrawn, according to relatives.

After a police investigation into the deaths, which happened between 1995-97, the Crown Prosecution Service decided that there was insufficient evidence to prosecute. Three members of the hospital staff have remained suspended on full pay for the past eight years.

The men were all terminally-ill patients suffering from dementia on the Rowsley ward at the Kingsway hospital in Derby. The 250-bed hospital was part of the South Derbyshire Mental Health Trust, providing long term psychiatric care for mainly geriatric patients.

The chairman of the inquest, the retired High Court judge Sir Richard Rougier, said that whatever the reasons behind the decision to withdraw food, the illnesses that it led to played an "inexorable progress" in their deaths.

He said that if "food and fluid was withdrawn at a time when they were perfectly capable of accepting it all because it was arbitrarily decided that it was time for them to die", it would amount to a policy that had been "totally unacceptable since the dark ages".

However, he said: "If it should transpire that food and fluids were withdrawn in good faith and in the not unreasonable belief that it was in their best interests as the lesser of two evils, committing them to die in as much comfort and dignity as possible. . . it would be grossly unfair to record a verdict other than that of death by natural causes."

Dr Claire Royston, a consultant psychiatrist, said that doctors often allow terminally ill patients to starve to death by deliberately stopping their food. She said dementia suffers often forget how to eat, leading to the risk of food going down the windpipe instead of the throats, causing choking or leading to pneumonia.
-------------------

This sort of practice has actually been going on "under the table" in the NHS for years. But what makes me most uneasy is the Judge's statement:

"If it should transpire that food and fluids were withdrawn in good faith and in the not unreasonable belief that it was in their best interests as the lesser of two evils, committing them to die in as much comfort and dignity as possible. . . it would be grossly unfair to record a verdict other than that of death by natural causes."

In other words, if medical professionals determined "it was in their best interest" to be starved and dehydrated in comfort and dignity then this would be "death by natural causes". Well yeah, starve me and I naturally drop dead. But this hardly considers the two more important questions: 1) Is it right to do so? 2) Did these men want to die in this ghastly fashion? 3) Since when is death medical therapy? 4) Since when is feeding someone who can't feed themselves "treatment"? and so on...

I should comment I'm not an entirely disinterested spectator, my Grandfather's death was "accelerated" by the decisions of the staff of a UK hospital because he too was suffering from senile dementia. This was against the express wishes of his family.

- SEAGOON

[Silat]

Originally posted by Seagoon
A while back we were discussing the case of Terri Schiavo, a woman who had not left instructions as to whether she wished to continue receiving food and water after she became incapcitated.

She did leave instructions. With her husband. The courts decided with 7 yrs of testimony that she had told friends and her husband.

[Silat]

Seagoon the way you have posted this leads to a very different conclusion than the facts show. It is nothing like your statement leads us to believe.

The GMC argued that the original ruling put doctors in "an impossibly difficult position" as it would oblige a doctor to provide treatment that the patient demands, even if the professional thought that it would be futile. The GMC believes that a patient does not have the right to demand any particular form of treatment.

Actually this case was about Drs being ordered by patients to provide any treatment they demanded.
The drs will not be starving this gentleman to death.


Lord Phillips, giving the ruling of the court, said: "Where a patient indicates his or her wish to be kept alive by the provision of artificial nutrition and hydration (ANH), any doctor who deliberately brings that patient’s life to an end by discontinuing the supply of ANH will not merely be in breach of duty but guilty of murder."


Where the Court of Appeal disagreed with Mr Justice Munby was over a situation where a patient’s request for ANH was against a doctor’s judgment that it would cause distress to the patient.


"Ultimately, however, a patient cannot demand that a doctor administer a treatment which the doctor considers is adverse to the patient’s clinical needs.


"This said, we consider that the scenario that we have just described is extremely unlikely to arise in practice."

[SOB]

Once the doctor decides that it's beneficial to end it, they should give the family the option of bringing their loved one home.  Then, they can pump food and water into 'em as long as they want, or for as long as they can afford.  That way they can enjoy the sack of flesh that used to be Grandpa for that much longer.  Personally, I prefer pictures and memories.

[Silat]

Your sources are very suspect Sea.
Media Research Center is as fanatical rightwing as it can get . Their articles are slanted so far to the right that they fall off the FLAT earth.

[Seagoon]

Originally posted by Silat
Your sources are very suspect Sea.
Media Research Center is as fanatical rightwing as it can get . Their articles are slanted so far to the right that they fall off the FLAT earth.

Hi Silat,

The info I originally posted was indeed from CNS, but they were put on to it by the British Media and Patients Rights Groups in the UK. The material from their article is available almost verbatim via a search in UK papers. Indeed the other articles were both from the UK press. Regardless, the source did not invent the case or the ruling. Neither did they invent the reactions of parents rights groups.

Now if you want to get into the politics of it, generally Socialists are in favor of Euthanasia and European socialists in particular have been agressively pressing for state determined Euthanasia at all levels for several years now, while by and large Conservatives have been pressing for the right to life and have been against Euthanasia, Abortion, and most forms of what they view to be medical murder. On this issue, the Libertarian community (whose views would match up with the majority of the patients rights groups in the UK) are pressing for the rights of patients and their family to determine the nature of his treatment and whether or not he lives or dies. In this case, the state medical community does not want the patient or his family to be the final arbiter of this decision.

Please note, this is not a "Heroic Measures" issue, feeding and hydrating a human being are not heroic and until recent redefinitions were not even classed as "treatment." Ultimately this is over whether or not the medical community can decide to Euthanize a patient (as a "therapy") via withdrawal of food and water regardless of previously stated desires. The medical community views this as "therapy" but the man in question, Leslie Burke, rightly viewed this as being killed contrary to his desires.

Silat, are you entirely comfortable with the idea that a doctor could decide that the best therapy for your incapicitated loved one might be to cut off food and water until they die? This decision can be made in the UK regardless of previously stated patient desires or even family input.

- SEAGOON

PS: Yes, CNS is conservative, but then again CNN is liberal. Do I spend all my time complaining about the obvious liberal bias of CNN, APP, Reuters, ABC, CBS, etc.? What would be the point? Unless there are obvious lies involved, I'd prefer to discuss the issues rather than impugning the messenger.