New medical guidance on brain-damaged patients is 'dangerous'


New guidance is putting brain-damaged patients at risk of being starved to death, the Care Not Killing alliance has warned.

The alliance, which campaigns for better palliative care as an alternative to euthanasia, strongly criticised the latest guidelines issued by the British Medical Association (BMA) and Royal College of Physicians (RCP).

The guidance, which is endorsed by the General Medical Council, covers decisions around providing clinically-assisted nutrition and hydration (CANH) to patients who lack the capacity to consent and who are not expected to die in the imminent future.

It advises that CANH should only be provided where the patient has given consent, or where it is in the best interests of patients who lack capacity.

In issuing the guidance, the BMA said that turning off a ventilator and CANH were a 'form of medical treatment'.  It also insisted that it was 'not a form of euthanasia'.

'Continuing to provide treatment (including CANH) that is not in the patient's best interests would be an unlawful act and an act that is positively harmful to that patient,' the BMA said.

Dr John Chisholm, BMA medical ethics committee chair, said: 'Decisions surrounding the withdrawal of clinically-assisted nutrition and hydration (CANH) pose clinical, ethical and legal challenges for doctors, and can be needed at an incredibly difficult time for patients' families and loved ones.'

He continued: 'The law is clear that CANH is a form of medical treatment, much like artificial ventilation, and while there should be a strong presumption that starting or continuing this treatment is in the patient's best interests, this will not always be the case.

'The aim of medical treatment is not simply to prolong life at all costs, and the courts have been clear that in some circumstances it will not be in the best interests of the individual patient to receive CANH.'

Care Not Killing said it was 'worrying' that the guidance extended beyond patients in vegetative or minimally conscious states to include those who had dementia or a catastrophic stroke.

'It means that clinical staff can now effectively starve and dehydrate people to death without having to go to the Court of Protection if it is deemed to be in the patients' "best interests",' the alliance said.

Steve Fouch, acting campaign manager for Care Not Killing, said the removal of court approval put patients at risk of unnecessary death.

'It removes an important safeguard from those without a voice and makes no allowance for emotional and financial pressure that loving families and medical staff will come under, whether perceived, or real,' he said.

He pointed to research released in August by the American Academy of Neurology, which revealed the challenges in accurately diagnosing the extent of brain damage in patients.

The research found that four in 10 people thought to be unconscious are actually aware while one in five people with severe brain injury from trauma will make a sufficient recovery that they will be able to leave hospital and care for themselves at home unaided.

Mr Fouch said the guidance from the BMA seemed to be 'terribly out-dated, even error-ridden' in light of the latest medical research.

'It also misses the ethical point that there is a clear difference between turning off a ventilator on a brain-dead patient and removing CANH from a brain-damaged patient, or those on a "downward trajectory",' he said

'CNK urges the BMA to review this guidance and in the light of our changing understanding of how patients should be assessed and cared for.'