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Sir, — Canon Robin Gill’s article on having achieved the correct fineness of balance I find a little misleading (Comment, 25 February). As someone who sits on the BMA ethics committee, he must be aware that passive euthanasia is an accepted, even recommended, practice in hospices and hospitals.
The current so-called euthanasia debate is all about active euthanasia, ending a life by positive actions. Nothing is ever said about passive ending of life; yet it happens, and not infrequently.
The GMC in its current guidelines (Treatment and Care Towards the End of Life: Good practice in decision making, 1 July 2010) to doctors states that nutrition and hydration provided by tube or drip are regarded in law as medical treatment, and should be treated in the same way as other medical interventions. If a patient is expected to die within hours or days, and you consider that the burdens of providing clinically assisted nutrition or hydration outweigh the benefits they are likely to bring, it will not usually be appropriate to start or continue treatment.
In effect, this means that a patient who is deemed to be near the end of his or her life and may well be unconscious — perhaps because of pain-reducing medication — can have nutrition and hydration removed. In theory, this is only deployed when a patient is near the end of life. In practice, this can mean as long as five weeks without food or drink. Withdrawal should be reviewed, but I have heard doctors rehearse the arguments to continue withholding nutrition and hydration rather than “risk” the patient’s coming round.
Despite the Mental Capacity Act, which requires the consideration of the best interest of the patient, the patient is rarely involved in the decision-making: rather, the next-of-kin, at a tremendously vulnerable time, is called upon to make a decision in a capacity far beyond his or her ability. It is passive, not active, but it is still euthanasia.
If passive euthanasia is seen as the appropriate action, why should we not have the moral courage to enact active euthanasia? If we cannot go this extra step, then the practice of this form of passive euthanasia —disguised as “withholding treatment” — should be brought to an end.
“We have left undone those things which we ought to have done; And we have done those things which we ought not to have done; And there is no health in us.”
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