Challenging Medical Ethics.
Volume 2. Patients in Danger: the Dark Side of Medical Ethics.
Editor Gillian Craig.
Published by Enterprise House 2006. ISBN 978-0-9552840-0-7 

Part 1. The Debate in Great Britain. 
Withholding treatment from people who are not dying. 


Treatment limiting decisions achieved prominence in the United Kingdom (UK) with the case of Tony Bland, an Englishman with a permanent vegetative state (PVS), who died when hydration and food, given via a tube, was withdrawn 1. Now the spotlight has moved to other people with long-term physical and mental illnesses that are disabling but not necessarily fatal. Many of these people are elderly and suffer from strokes, dementia or other degenerative diseases. Others have brain injury due to accidents or infections. Some are born with disabilities and never enjoy a normal life.

Many such unfortunate people have some degree of mental incapacity or infirmity but are cared for lovingly by their family, or in nursing homes or other institutions. Their quality of life may be poor as judged by normal standards, but they are nevertheless people and entitled to the full protection of the law. That protection can no longer be guaranteed.

Doctors are often faced with difficult questions about how far to go in prolonging life by measures such as tube feeding. Sometimes their views differ from those of the family. Insensitive handling can have adverse emotional effects on dissenting relatives. The whole issue of who decides, and makes the final judgement is now under intense discussion by the medical profession, lawyers and society as a whole. Medical ethics is moving into dangerous territory.

Anglican and Roman Catholic Bishops made a valuable contribution to medical ethics in 1993, when they stated some important guiding principles on the distinction between killing and letting die. They said… 

“Doctors do not have an overriding obligation to prolong life by all available means. The Declaration on Euthanasia in 1980 by the Sacred Congregation for the Doctrine of the Faith proposes the notion that treatment for a dying patient should be proportionate to the therapeutic effect to be expected, and should not be disproportionately painful, intrusive, risky or costly in the circumstances. Treatment may therefore be withheld or withdrawn. This is an area of fine judgement. Such decisions should be made collaboratively and by more than one medical person. They should be guided by the principle that a pattern of care should never be adopted with the intention, purpose or aim of terminating the life, or bringing about the death of a patient. Death, if it ensues, will have resulted from the underlying condition which required medical intervention, not as a direct consequence of the decision to withhold or withdraw treatment. It is possible however, to envisage cases where withholding or withdrawing treatment might be morally equivalent to murder.” 2  

…The important question of whether artificial hydration and nutrition (AHN) should be regarded as medical treatment is discussed in some detail in the first chapter of this book, the issue being considered from various aspects- Christian, ethical, legal, medical and purely practical. The author shares the view of the House of Lords’ Select Committee on Medical Ethics of 1993/94, for their Lordships found it impossible to make a firm ruling. Food and fluids, by whatever means they are given, are best regarded as a basic human need… 

Also by Dr. Gillian Craig Challenging Medical Ethics Volume 1: No Water-No Life: Hydration in the Dying

This book highlights the ethical, legal and medical; dangers of a regime of sedation without hydration in the dying and documents a decade of debate on this subject. It will challenge and inform readers in many walks of life. Reprints of key papers give the views of the main protagonists. Illustrative case reports reveal the complexity of the situation and show the plight of dissenting relatives, some of whom suffered symptoms of post-traumatic stress. International aspects of the debate are explored. A chapter on legal issues looks at double effect and the neglect factor. Some professional guidelines from the UK are reviewed.
Dr Robin Fainsinger a Director of Palliative Care Medicine in Canada who is known for his work in this field, found the book “fascinating and informative”. Reviewing the book for the Catholic Medical Quarterly in February 2006 he wrote “Dr Craig has performed a great service to palliative care for her thoughtful approach in challenging a long held dogmatic practice…”