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Why the BMA guidance on CANH is dangerous
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  • Published on:
    The real danger lies with doctors acting in a way that is not in the best interest of the patient
    • John Chisholm, Medical ethics committee chair British Medical Association

    Dr Anthony-Pillai is wrong to argue that the BMA and Royal College of Physicians’ guidance on decisions about clinically-assisted nutrition and hydration (CANH) is dangerous in overlooking the symptomatic benefit that CANH can provide.

    Our guidance, which was developed over a period of 18 months, in conjunction with a range of medical, legal, and ethical experts, is professional guidance, setting out the process that needs to be followed in order to comply with the law and good practice. We are clear that the guidance should be read in conjunction with the most up-to-date clinical guidelines when reaching a decision, and that any significant divergence from established practice must be justified. It is the clinical guidance which is the most appropriate home for discussion on assessing and responding to symptomatic distress. For patients who are in a prolonged disorder of consciousness (PDOC), this will be the clinical guidelines on PDOC from the Royal College of Physicians – who were the joint authors of our guidance. (These guidelines are currently under review by the RCP’s PDOC guideline development group following recent changes to the law. The updated version is expected to be published in early 2020.)

    We do not, as Dr Anthony-Pillai suggests, only “implicitly acknowledge” that CANH can provide symptomatic benefit. We explicitly state at the outset, in determining the scope of the guidance, that “clinical benefit” encapsulates not just prolonging some...

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    Conflict of Interest:
    I am chair of the BMA's medical ethics committee