Family Practice Vol. 17, No. 3, 276
© Oxford University Press 2000
Book Reviews |
Withholding and withdrawing life-prolonging treatment: guidance for decision making.
GP and Lecturer in general practice at the Royal Free Hospital Medical School and honorary senior lecturer in medical anthropology at Brunel University
We are looking after a woman who, 4 years after a dense stroke, manages to continue to live though is essentially unresponsive and most probably in a persistent vegetative state (PVS). It is therefore with great relief that I was asked to review the book Withholding and Withdrawing Life-prolonging Medical Treatment since one of the obvious questions for me is how long could this go on and could (should) we as GPs intervene?
The book is the accomplished outcome of the British Medical Association (BMA) Ethics committee whose 25 members include the ‘great and the good’ of a medico-legal, political and academic caucus and whose knowledge and expertise cannot be challenged in the UK. Much of the work was carried out in 1998/9 after an open consultation exercise (explained in the Acknowledgements) in which over 2000 responses were collated and examined when guidance was being actively sought.
The book itself comprises five parts, with ‘Setting the scene' and an ‘Executive summary' forming parts one and five. The remaining chapters are about decision making, including guidance on adults who have left advance directives and on the care of children or babies. The chapters on the ‘legal aspects' of individual cases are valuable since they describe what has been tested (and thus what has not) in the courts—an important and necessary facet of the whole text.
The book is an excellent read since the subjects, far from being clear, are presented succinctly, concisely and diligently. Although cynics dislike writing by committee, there is little evidence of that here—perhaps due to a designated project manager and co-writer of the text. The advice is sensible, relevant and overwhelmingly practical.
According to a Defence Union journal, a doctor recently was suspended for 6 months for serious professional misconduct having withheld nutrition from a patient. Intuitively, the case that I mentioned at the start of this review might be approached in the same way. The beauty of this BMA book is that its simple guidance will allow ordinary clinicians to practice safe medicine while meeting the needs of individual patients and their families. In doing this, they will be able to protect themselves from professional misconduct committees and, importantly, the savagery of morning headlines. Not bad for an 80 page book!
Notes
BMA Medical Ethics Committee. (102 pages, £9.95.) BMJ Publishing Group, 1999. ISBN 0-7279-1456-1.
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