New testament

The British Medical Association (BMA) recently published guidance from its medical ethics committee on decision making concerning the withholding and withdrawing of life-prolonging medical treatment.¹ It is a very thoughtful and thought-provoking document, the ramifications of which go far beyond the immediate situation it is addressing. The authors are clearly well aware of this. When considering a doctor's ethical response to “contemporaneous requests for life-prolonging treatment” made by competent patients, the committee observes:

“Although patients' wishes should always be discussed with them, the fact that a patient has requested a particular treatment does not mean that it must always be provided.”²

They advance four propositions in support of this conclusion, namely:

1. Health professionals are not obliged to provide any treatment which cannot produce the desired benefit”.³

2. There is no obligation to provide any treatment which is clearly contrary to an individual's health interests. A life-prolonging treatment may, for example, prolong life but result in severe pain or loss of function so that overall it produces severe harm to the patient”.⁴

3. Except in an emergency situation, doctors are not obliged to treat contrary to their conscience (though they may be obliged to make an appropriate referral)”.⁴

4. Where resources are limited, it is inevitable that some patients will not receive all of the treatment they request even though such treatment could be potentially beneficial to them”.⁴

Towards the end of their commentary on the last of these propositions, they observe:

“Health professionals have an ethical duty to make the best use of the available resources and this means that hard decisions must be made. Whilst this is a much broader issue than can be discussed thoroughly in this document, it is clear that doctors are not obliged to comply with patients' requests for treatment when they …