Two related news items may interest, and even challenge, readers. Judges in the High Court of the UK have just (July
2004) ruled that doctors will only have the right to withdraw treatment from patients if their lives have become intolerable. The ruling came in a case brought by a terminally ill man with a degenerative
condition, who argued that it should be for him, and not his doctors, to decide whether to withdraw artificial feeding from him after he is unable to move or speak. Until now the decision whether
or not to continue with hydration, feeding etc. was largely based on doctors’ assessments of ‘quality of life.’ Now the General Medical Council will have to replace its ‘
quality of life’ guidelines with a tougher ‘ intolerability’ test. The London ’ Times’ commented that "the ruling reflects a shift of power from the medical
profession and into the hands of patients. It also, however, forms part of a less welcome shift in power, out of the hands of practitioners and into the arms of the courts." (Saturday July
Assisted suicide is firmly back on the UK agenda. Baroness Warnock, the brilliant academic and author of the report
some years ago which came down against it has declared that she is now persuaded of its worth. One of the UK’s three leading political parties - The Liberal Democrats - has made it a party
political issue. A recent opinion poll has shown that 80% of the British public are in favour of assisted suicide.
All of us in palliative care will surely welcome discussion of patient rights and patient autonomy, and applaud anything
which reminds us and our clinical colleagues of the necessity to discuss everything with our patients and to be aware of their wishes, difficult as that can be when they change so frequently with
every twist and turn in their condition. Presumably we shall welcome this further reminder, if any was needed, that palliative care always has a place, always focuses on quality of life, and always
puts the patient at the centre of our thinking.
Will we be left wondering how ‘intolerability’ will be defined by individual patients, how it might be measured,
and how patients unable to communicate with us will inform us of their wishes? Will it be long before we discover, what some of us have long suspected, that assisted suicide is the thin end of the
wedge, the last step before legalisation of euthanasia?
Today’s news items will make good discussion points for our patients and topics for our tutorials but, worldwide,
they deserve more serious attention than this and who better to address such issues than those of us who work in palliative care.