Family & Life

Doctors Alerted to Dangers of Advance Care Directives : 21st Jan 09

Doctors Alerted to Dangers of Advance Care Directives

In a letter to the "Irish Medical News", Family & Life’s Patrick Carr expressed concern over possible changes to Irish law regarding advanced care directives. The Law Reform Commission (www.lawreform.ie) is now conducting a consultation on those legal documents.

“In an age where patient autonomy has been elevated to the supreme good which trumps all others”, he noted, “and where Internet-based self-diagnosis is increasingly common, this raises questions which should be of concern to all medical professionals.”

Proposed legislation on Advance Care Directives has caused controversy in other countries, Mr Carr pointed out, “partly because there has often been a failure to distinguish adequately between what is medical treatment and what is normal nursing care”.

Providing nutrition and hydration is an ordinary and proportionate means of preserving life, so people should generally see it as part of normal nursing care. This is true even when the patient receives it by artificial means. Though acts such as inserting a feeding tube and prescribing the proper formula are medical acts, they are usually not things that one would call unduly burdensome. There should be a presumption in favour of providing nutrition and hydration to all patients, except when there’s no reasonable expectation that they’ll sustain the patient’s life, or where they’d pose excessive risks or burdens for him or her.

Mr Carr said he hoped many Irish doctors would convey their views on this matter to the Commission before the end of January. “A law which could allow a situation where a doctor could be obliged to cause or facilitate the death of a patient by starvation or dehydration would not serve the interests of either.” Irish Medical News, January 12.

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Family & Life

Doctors Alerted to Dangers of Advance Care Directives : 21st Jan 09

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