International Association for Hospice & Palliative Care

International Association for Hospice & Palliative Care

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Promoting Hospice & Palliative Care Worldwide

International Association for Hospice & Palliative Care

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"Promoting Hospice and Palliative Care Worldwide"


2004; Volume 5, No 8, August

IAHPC Regional Report - UK


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The right to live and the right to die in the United Kingdom
Derek Doyle OBE, MD (Edinburgh)

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 31)

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.