GMC faces challenge over withdrawing treatment

The General Medical Council faces an unprecedented challenge in the High Court in London next month to its guidelines for doctors on withholding and withdrawing life prolonging treatment.

A man with cerebellar ataxia claims that the guidance, published in 2002 after extensive consultation, is unlawful and effectively allows doctors to perform euthanasia.

Leslie Burke, 43, from Lancaster, is capable of making his own decisions, but he fears that doctors may decide at a point when he is no longer competent that his life is not worth living and discontinue artificial feeding.

The GMC's guidelines cover the circumstances in which doctors may withhold or withdraw artificial nutrition and hydration when patients are mentally incompetent.

In English law the doctrine of necessity allows doctors to make decisions on treatment in the patient's best interests if the patient is a mentally incompetent adult. The courts have held that artificial nutrition and hydration count as treatment.

Ten years ago, in the case of Tony Bland, a survivor of the Hillsborough football ground disaster, the House of Lords held that where a patient is in a permanent vegetative state doctors should seek a court declaration that artificial feeding is no longer in the patient's best interests. The guidelines are intended to cover other conditions.

Laurence Oates, the official solicitor, who has been brought into the case to advise the court, said: “At the moment we have very clear authority from the Bland case that in the extreme cases of persistent vegetative state you need to go to court. And yet if you're comatose and unaware for other reasons there is no legal authority to say doctors must go to court.”

Mr Burke argues that human rights law dictates that the court, not doctors, should take such life or death decisions. “I feel very strongly that if I ever end up in hospital in the position where my life is in the balance, doctors should not be able to make the final decision on whether my life is worth living or not.”

The GMC's guidance covers the situation where a patient's death is not imminent but where doctors judge that the patient's condition is so severe and the prognosis so poor that providing artificial nutrition or hydration may cause suffering or be too burdensome in relation to the benefits.

A decision to withhold or withdraw feeding or hydration may be made only after a full assessment of the patient's requirements and the possible means of providing nutrition and hydration, after a full consultation with the healthcare team and the people close to the patient, and after a second opinion from a senior clinician who is not already directly involved in the patient's care.

Mr Burke's solicitor, Paul Conrathe, said: “This case raises fundamental issues concerning the protection of the rights of the most vulnerable in our society. We are concerned that Mr Burke's right to life under the European Convention on Human Rights could be violated without the protection of due legal process.”

A GMC spokeswoman said: “It's the first time this area of our work has been subject to judicial review. We consider, after the consultation process we have been through, that the guidance is consistent with the law.”