Withholding and withdrawing artificial nutrition and hydration : is it a permissible omission?

Abstract

The aim of this thesis is to consider the current legal position with respect to Artificial Nutrition and Hydration (ANH). The advances in modern technology are reflected in the medical field. This leads to situations where the medical profession is faced with dilemmas about the permissibility or otherwise of the withdrawal or withholding of ANH. According to law and medical opinion, ANH is to be regarded as treatment. This means that the competent patient is to have an option to refuse ANH, even if it leads to his death, whilst the basis of deciding such an issue in respect of incompetent patients rests principally on the consideration whether the actual duty of care of the medical profession would extend to impute liability, criminal or otherwise, if ANH is to be withdrawn or withheld. The main consideration, in this context, is whether such an action should be considered as an omission or otherwise. In the UK, the above is to be exercised on the basis of, what is the ‘best interests’ of the patient, it being exercised within the restraints inherent in the exercise of ‘duty of care’, which the medical profession has towards the patient. The principle of Bland was extended to cover situations which had not been necessarily intended when Bland had been decided. This was a natural consequence of the fact that ANH was regarded as treatment – a principle which was further reflected and strengthened by the issue of the General Medical Council (GMC) Guidelines. This has led to a situation where justification for withdrawing ANH, and so avoiding liability, is becoming somewhat 'easier' to bring about.