A professor has suggested in the BMJ that hydrating and feeding dementia patients 'skews' resources
Hydrating and feeding dementia patients is a waste of the National Health Service’s resources, a leading medical ethicist has said.
In an article for the British Medical Journal, the chairman of the Institute of Medical Ethics criticised a High Court judgment in September last year, which concluded that it would not be in the best interests of a brain-damaged woman to withdraw her artificial hydration and nutrition.
Writing under the heading “Sanctity of life has gone too far”, Professor Raanan Gillon, who is also an emeritus professor at Imperial College London, said: “The logical implications of this judgment threaten to skew the delivery of severely resource-limited healthcare services towards providing non-beneficial or minimally beneficial life-prolonging treatments including artificial nutrition and hydration to thousands of severely demented patients whose families and friends believe they would not have wanted such treatment.
“The opportunity cost will probably be reduced provision of indisputably beneficial treatments to people who do want them.”
In September last year Lord Justice Baker refused to end the life of a minimally conscious woman by permitting the withdrawal of her food and water.
The woman, known as M, was in a minimally conscious state following a brain injury in 2003. Her mother and sister argued that she would not want to be kept alive in such circumstances and appealed to the High Court for the withdrawal of M’s artificial hydration and nutrition. She was not receiving any other life-sustaining treatment other than food and water.
Mr Justice Baker rejected their request, saying: “The factor which does carry substantial weight, in my judgment, is the preservation of life. Although not an absolute rule, the law regards the preservation of life as a fundamental principle.”
But Professor Raanan Gillon argued that the judgment defied common sense and the Hippocratic oath. He wrote: “Since Hippocratic times (at least) the primary goal of medicine has been to benefit people’s health. Until recently, the exercise of doctors’ very limited capacities to prolong life has almost always led to such benefits. Now, however, medical advances have led to a vastly increased capacity to keep people alive without, in many cases, providing any real benefit to their health.
“This recent judgment, and the practice directions of the Court of Protection, logically imply that doctors should no longer decide, in consultation with those who know their incapacitated patients, whether life- prolonging treatment including artificial nutrition and hydration will be in their patients’ best interests.”
Professor Gillon concluded: “Unless this judgment is overturned or modified by a higher court it will gradually and detrimentally distort healthcare provision, healthcare values and common sense.”
At the time of the appeal Caroline Harry Thomas QC, the Official Solicitor appointed to represent M, said: “In M’s case, a person is in a minimally conscious state and is otherwise clinically stable. It cannot, as a matter of law, be in that person’s best interest to withhold or withdraw life-sustaining treatment, including artificial nutrition and hydration.” She said that as such treatment was withdrawn from M, it would amount to the “actus reus [guilty act] of murder”.
Meanwhile, a man suffering from locked-in syndrome recently won a High Court battle to proceed with his request to allow doctors to end his life. A High Court judge ruled in March that Tony Nicklinson’s case could proceed to judicial review.