BMA clarifies position on Mental Capacity Bill

Dec 13 2004

The Mental Capacity Bill is going to report stage tomorrow in the House of Commons. There have been articles in the press incorrectly linking this Bill to euthanasia. The primary focus of the Mental Capacity Bill is to protect patients who have lost their ability to make their own decisions.

The following presents clarification on end of life issues and the BMA position on these topics:

The Mental Capacity Bill:

The BMA supports this Bill as for the first time the following will be enshrined in law: A Lasting Power of Attorney (LPA) permits the appointment of specific individuals, chosen by the patient, to make decisions on their behalf about life-prolonging treatment. Without an LPA, decisions would need to be made by health professionals in discussion with those close to the incapacitated person, but no-one has the legal right to make such decisions. An LPA therefore enhances the voice of the incapacitated person. An Attorney can only make decisions regarding the withdrawal or withholding of life-prolonging treatment where the LPA specifically authorises it, i.e. where the incapacitated person has specifically granted that power. Where an individual retains the capacity to make and to communicate a decision, even if the method of communication is via a series of movements, such as blinking, those views will override any advance statement or refusal which only takes effect when capacity is lost.

The Bill does NOT bring in euthanasia through the back door. It grants incapacitated people the same rights as other members of society.

Living Wills (or advance statements):

Patients who understand the implications of their choices can state in advance how they wish to be treated if they suffer loss of capacity. Valid advance statements are already legally binding ? the Mental Capacity Bill simply clarifies this situation.

The Assisted Dying Bill:

Lord Joffe introduced this Bill to Parliament in November 2004. The Bill enables a competent adult, who is suffering unbearably as a result of a terminal illness, to receive medical assistance to die at his own considered and persistent request; and to make provision for a person suffering from a terminal illness to receive pain relief medication. The Bill is currently undergoing scrutiny.

The BMA does not support euthanasia and therefore is not backing this Bill.

Withholding and withdrawing treatment: The primary goal of medicine is to benefit the patient. The BMA supports the view that if medical treatment can no longer benefit the patient then, ethically, the doctor must start to consider whether it should be withdrawn.

This must be done carefully and thoughtfully, in consultation with the patient when possible, with relatives, in close discussion with the whole team of people involved in the care of the patient and, in some circumstances, with outside advice from another doctor.

If the patient's family and the doctors do not agree about a decision to withhold and withdraw treatment then the only way forward is for the case to go to court.