By Alex Schadenberg
The Interim

On Jan. 28, 2000 the Medical Treatment (Prevention of Euthanasia) Bill passed through second reading in the British House of Commons by a vote of 113 to 2. The Prevention of Euthanasia Bill was introduced on Dec. 15, 1999 by Ann Winterton, member from Congleton, in order to amend the law in relation to the withdrawal or withholding of medical treatment or food and fluid from patients for the purpose of causing the death of the patient.

The bill would prohibit the withdrawing or withholding of medical treatment, or the withdrawal or withholding of sustenance with the intention of causing the death of a patient, and for connected purposes.

The important sections of this bill define nutrition and hydration as “sustenance” rather than medical treatment, thus protecting the vulnerable from unscrupulous family, friends or medical care-givers who would rather starve the patient to death than provide continuing normal care. This bill also makes it clear that it is illegal to intentionally hasten a person’s death, thus clearly defining euthanasia as both an action or an omission of an action with the intention of causing a death.

The strong support for the bill probably stems from the recent history of euthanasia by omission in Britain.

In 1992, the British Medical Association (BMA) circulated a document which defined artificial feeding as medical treatment. This document was then used in 1993 to justify the decision to allow Anthony Bland to starve and dehydrate to death, now known as the Bland Ruling.

The judgment caused such public concern that the House of Lords established the Select Committee on Medical Ethics to consider euthanasia and the treatment of the sick and dying. Its unanimous report was published in 1994 and opposed euthanasia. It also opposed the concept that living wills could be legally binding, and that the Bland judgment should be enshrined in statute.

In addition to opposing the principle of doctors killing patients, the Select Committee was seriously concerned about the obvious abuses that that could lead to, when old and vulnerable people might be pressured into agreeing to have their lives ended. It had been made clear to the Select Committee by a number of organizations, including doctors involved in care for the dying, that the only reason for defining assisted food and fluid as treatment was to enable doctors to bring about the deaths of patients whose lives they thought were not worth living.

In 1995, the Law Commission report on mental incapacity was published. Although the law commissioners paid lip service to the House of Lords Select Committee, claiming to support its decisions against euthanasia, their report included a proposed bill in which were clauses to make advance directives – living wills – legally binding. There was also a clause that would have enshrined the Bland judgment in statute.

In December 1997, the government published “Who Decides?” – a consultation document on care of the mentally incapacitated. This followed very closely the report of the Law Commission, and appeared to accept the concept of medical killing by the withdrawal of assisted food and fluid, thus causing death by starvation and dehydration. The document provoked a large and robust response, with more than 4,000 submissions.

Since the Bland judgment, the British Medical Association has sought to widen the circumstances in which it is allowable to withdraw assisted food and fluid. In June 1999, the BMA produced guidance on withholding and withdrawing life-prolonging medical treatment. It included the recommendation that tube feeding could be withdrawn on the agreement of only one independent doctor for a wide selection of people such as those who have had severe strokes or those with dementia, even those who are not dying.

Even though the BMA maintains a position of opposition to euthanasia by omission, it continues to define assisted feeding as medical treatment, thus enabling unscrupulous family, friends and medical care-givers to intentionally end the lives of vulnerable patients by starvation and dehydration. The BMA position might have been precipitated by the case of Dr. David Moor, who was acquitted in Britain for intentionally overdosing a patient with diamorphine in order to hasten his death.

Since the release in June 1999 of the BMA guidelines on the withdrawal and withholding of assisted feeding there have been over 60 cases that have been reported to the authorities, and which are now being investigated, in which it is suspected that patients were denied food and drink in order to hasten their deaths. The proportion of abuse that has arisen in Britain in such a short period of time led the House of Lords on Dec. 15, 1999 to condemn the withholding of food and drink from patients and it has led to the successful introduction of Mrs.Winterton’s bill in the House of Commons.

The BMA claims that the bill is too wide in its scope and would force physicians to perform futile treatments on dying patients who do not wish to continue treatment. But the bill states in its preamble that it “prohibits the withdrawal or withholding of medical treatment, or the withdrawal or withholding of sustenance, with the intention of causing the death of a patient; and for connected purposes.” Therefore the bill is clearly about intentional acts to cause death and not acts that unintentionally cause death.

Since we are also seeing cases of withdrawal and withholding of assisted feeding for the intention of hastening death in Canada and since the Canadian Senate Committee on Euthanasia and Assisted Suicide in 1995 defined assisted feeding as medical treatment, therefore I believe that we will also face a similar situation, in which vulnerable Canadians will be subject to neglect and intentional starvation and dehydration.