The General Medical Council
22/11/05

Dear Sir/ Madam

Your report on the Court of Appeal judgement in the current GMC Today , failed to mention the circumstances in which a doctor would have “no answer to a charge of murder”, to quote from the judgement itself. This is a surprising oversight in the profession`s regulatory body.

The relevant sections are 32, 33 and 33 of the judgement (Case C1/1004/2086, Court of Appeal ( Civil Division ).

With regard to the duty to supply ANH

Para 32,........ “Where ANH is necessary to keep the patient alive the duty of care will normally require a doctor to supply ANH”.

And at 33.....it goes on to say

“The courts have acepted that where life involves an extreme degree of pain, discomfort or indignity to a patient, who is sentient but not competent and who has manifested no wish to be kept alive, these circumstances may absolve the doctor from the positive duty to keep the patient alive”..

At 34...... “No such difficulty arises, however, in a situation that has caused Mr Burke concern, that of a competent patient who, regardless of the pain, suffering or indignity of his condition, makes it plain that he wishes to be kept alive. No authority lends the slightest countenance to the suggestion that the duty of doctors to take reasonable steps to keep the patient alive in such circumstances may not persist. Indeed, it seems to us that for a doctor to deliberately interrupt life-prolonging treatment in the face of a competent patient's expressed wish to be kept alive, with the intention of thereby terminating the patient's life, would leave the doctor with no answer to the charge of murder”.

Your mention of “the patient`s palliative care needs must be assessed and met appropriately” is no comfort to a sentient patient dying of thirst. There are no palliatives which can relieve thirst. Mr Burke is seeking an appeal to the highest court in the land on this very point. Why is it that the extremity of dying from thirst is never mentioned in your guidance at any time in your article. Surely honesty demands that this be addressed.

Yours sincerely,

Dr A Cole
Chairman
MEA