Just to restate the principles

• Futile treatment should be discontinued. Chemotherapy and life-support are overused in the USA, sometimes with financial motives, and can give people awful deaths.
• Hydration and food like glucose to keep a body ticking over, however administered, should not be classed as medical treatment. They should never be discontinued or denied with the intention of ending a patient’s life.
• When someone is definitely dying, artificial hydration pushes them into heart failure, makes them wet the bed, drool on the pillow and get a death rattle which is awful for relatives. Hospice doctors and geriatricians have a horror of a law which would oblige them to do this.
• The solution is to record in the patient’s notes that hydration is being stopped because the patient is now dying. The Profession should be told to prepare clear guidelines to help doctors decide when that time has arrived. Of course there will be mistaken decisions occasionally. Of course an element of trust in the Profession has to be present. Of course ill-will will occasionally produce a doctor who abuses the trust.
• Clearly a person with a possibly-reversible coma is not to be classed as dying. Professional guidelines are well-known, and try to make the most accurate prediction possible. Equally clearly, anyone who is at all responsive must be given fluid to avoid suffering, by mouth if possible.
• We need a definite statement of good-will from the Government which says that measures intended to hasten a patient’s death are never acceptable, and shortage of resources can simply never be cited as a reason for such decisions.

10th March 2005

Dr. Richard Lamerton Medical Director Hospice of the Valleys South Wales

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