Briefing on the Mental Capacity Bill (2004)
Prepared by: The Linacre Centre, the Centre for Bioethics and Public Policy, CARE,
the Christian Peoples Alliance, the Guild of Catholic Doctors and the Medical Ethics Alliance. A pdf of this report is available here.
On the face of it, Those who save the lives of such suicidal patients may be liable to criminal proceedings, if the patient was mentally competent in refusing treatment. In contrast, carers are apparently free to withhold life-saving treatment even with the aim of causing death.
Take the following scenario:
P is a person who wants to commit suicide when his disability progresses beyond a certain point. P makes an advance decision, when he is mentally competent, that no treatment is to be given to him should he be (temporarily or permanently) unconscious. Later, P attempts suicide unsuccessfully and is unconscious as a result.
There is nothing in the Bill which explicitly prevents intentional homicide by omission, which the Bland judgement has already legalised in the case of PVS patients. While we note Clause 58 to the effect that nothing in the Bill will change the law on homicide or assisted suicide, it should be remembered that the law in these areas has already been seriously weakened by Bland and other judgements. The Bill does not say that homicidally-motivated denials of life-saving treatment by doctors or proxy decision-makers will be invalid. Nor does it exclude suicidally-motivated advance decisions from those which are given legal force.
Even patients who have never wished to end their own lives will be at risk. The Bill does not acknowledge that doctors or proxies may have a homicidal motive in denying treatment to a patient. In the case of proxies, there are other dangers in allowing those with no medical qualifications to veto treatment which a doctor sees as medically required. Some vetoes will be aimed at causing death, while others will be, at very least, harmful to the patient, even if well-intentioned. The onus will be on the doctor to take such cases to court: a burdensome option many doctors (and NHS Trusts) will not wish to pursue.
Competent patients have rights in existing law to refuse treatment in advance. We have no problem with respecting advance refusals of treatment which are well-informed (i.e., where the relevant medical facts have been explained by health professionals) and which are not suicidally motivated. However, this will not apply to many advance decisions, and
In any case, we believe that no advance refusal should be binding in regard to basic care - including the provision of pain relief, hygienic care and feeding, whether orally or by tube.
Such a view goes against the whole practice of suicide prevention, and support for those who see their lives as worthless at some particular time.
This is dangerous, in view of the attitudes of some in the medical profession to such patients. It is one thing to do research which is intended to benefit the patient, as well as increasing human knowledge; it is something quite different to carry out invasive procedures which are solely for the benefit of others. We should not create structures which will, or may, allow mentally disabled people to be abused.