News Analysis

Britain: Moving the goalposts on euthanasia


The Supreme Court takes another step away from Church teaching

There is utter clarity about Catholic teaching on the withdrawal of clinically assisted nutrition and hydration from a patient to bring about death: it constitutes an act of euthanasia.

Pope St John Paul II was uncompromising on this point. In an address in 2004 he told a conference on treating patients in a vegetative state that the withdrawal of nutrition and hydration, “if done knowingly and willingly” to end the life of a patient, represents “true and proper euthanasia by omission”.

Even before that time our own bishops were speaking against the practice, having witnessed a steady erosion of medical ethics after the law lords reclassified nutrition and hydration as a form of treatment in 1993 so doctors could end the life of Tony Bland, a victim of the Hillsborough disaster.

The Bland judgment marked the crossing of the Rubicon. It was followed by government-backed guidance on treatment withdrawal by the British Medical Association, from the General Medical Council, and finally the Mental Capacity Act of 2005.

End-of-life care involving the withdrawal of food and water was codified into the Liverpool Care Pathway and other protocols and rolled out across the country via financial incentives for creaking NHS trusts.

Scandals inevitably followed, with more than 1,000 families complaining about abuses, including the alleged dehydration of relatives who were not dying.

The LCP was scrapped but, according to critics, its most lethal elements were retained, and families today continue to complain about the dehydration of their loved ones on NHS wards.

So what conclusions can be surmised from the ruling by the Supreme Court last week? It permits doctors to bypass the Court of Protection and to withdraw food and water from someone in a vegetative or minimally conscious state – as long as the doctor and the patient’s family agree that this is in the patient’s “best interests”.

It is tempting to see the ruling as an academic exercise, given existing practices within the NHS, and also because it focused on the case of Mr Y, a severely brain-damaged man in his 50s who is already dead. (The case continued so that a ruling could be made.)

Yet according to Dr Peter Saunders of Care Not Killing, the anti-euthanasia coalition, Britain’s highest court has “dramatically moved the goalposts on end-of-life decision-making”.

Not only has the ruling removed “an important layer of legislative scrutiny and accountability and effectively weakens the law”, Dr Saunders argues, but “it will make it more likely that severely brain-damaged patients will be starved or dehydrated to death in their supposed ‘best interests’ and that these decisions will be more influenced by those who have ideological or financial vested interests in this course of action”.

He said that because it costs about £100,000 a year to care for such a patient, “the potential ‘saving’ for the NHS could be as much as £2.4 billion annually if most seek to go down this route”.

The judgment also appears to give more power over life or death to doctors by allowing them to judge if a patient’s quality of life is so poor and hopeless that they should die.

These individual doctors will be the ones to decide if withdrawal of food and water will be in the patients’ “best interests”, especially when there is no power of attorney.

There are 24,000 people in the same dire situation as Mr Y, yet the impact of the ruling is likely to be felt throughout the health service – in spite of the caveat, offered by the Supreme Court, that legal applications should be made in cases where relatives disagree with medical opinion.

Catholic doctors are now advising people to make clear in advance of falling ill that they do not wish to be dehydrated. The English bishops, for their part, responded by returning to first principles, with Auxiliary Bishop John Wilson of Westminster, a moral theologian, emphasising that clinically assisted nutrition and hydration is “not treatment” but basic care which prevents death by “malnutrition and dehydration”.

“It cannot be in a patient’s best interests, whatever their level of consciousness, to have their life intentionally ended,” he said.

Another bishop, Philip Egan of Portsmouth, drew criticism last month after he warned Catholics to be alert to the possible deliberate killings of seriously ill patients in NHS hospitals.

Speaking after the publication of a report into 650 premature deaths at the Gosport Memorial Hospital, he urged people to be ever vigilant to policies and procedures within the health service. “If you or a loved one is terminally ill, consider whether it might be practicable to die at home,” he said.

“Ask whether it is possible for drugs to be used that do not totally withdraw consciousness,” he continued. “Gently insist on being involved in decisions. It might be appropriate to ask staff for a second opinion or a re-evaluation of treatment.”

It is “not morally permissible until the very last to withdraw feeding and hydration”, he said, adding: “We need to go back to basics.” Until this happens, the likelihood is that our hospitals are going to be increasingly dangerous for the people they were established to serve. Thanks, in part, to this latest decision.