The right for terminally ill people to demand life-prolonging treatment could force the NHS to provide inappropriate care, the court of appeal heard today.
A high court ruling last year that terminally ill people, and not their doctors, should ultimately decide whether they receive artificial nutrition or hydration (ANH) to prolong their life would lead to the misuse of NHS resources, according to the Department of Health (DoH).
Backing a challenge by the General Medical Council (GMC) to the ruling, the health department claimed that if a right to ANH was established, patients would be able to demand other life-prolonging treatments.
Philip Sales, representing the health secretary, Patricia Hewitt, said the right to ANH had "very serious implications for the functioning of the NHS".
"It may be interpreted as giving patients the right to demand certain treatments, contrary to the considered judgment of their medical team, that would lead to patients obtaining access to treatment that is not appropriate for them, and to inefficient (and unfairly skewed) use of resources within the NHS," Mr Sales told a panel of three appeal judges headed by the master of the rolls, Lord Phillips.
He said under current GMC guidelines to doctors a competent patient was entitled to decide on the treatment options offered to him by his doctor.
"But the patient cannot require his doctor to offer him any treatment option which, in the doctor's view, is not clinically appropriate or which cannot be offered for other reasons - having regard to the efficient allocation of resources within the NHS," he added.
Mr Justice Munby last year ruled that if a patient is competent, or has made a request before becoming incompetent, doctors have a duty to provide ANH.
Mr Sales said this ruling had led to a confusion between the responsibilities of doctor and patient - the decision over treatment was for the doctor, not the patient.
The DoH also backed the GMC's view that imposing an absolute obligation on doctors withdrawing treatment to find another doctor who will provide treatment could involve "extensive and potentially fruitless administrative effort to the detriment of other patients".
Last year's ruling came after Leslie Burke, who has a degenerative brain condition, took the GMC to court because he feared his wish to go on living until he dies naturally could be overridden under its guidelines.
Mr Justice Munby said although the bulk of the guidelines were in place to reassure patients and relatives, he took issue with them "in a limited number of respects" and ruled parts unlawful.
Mr Burke, 45, won the right to stop doctors withdrawing ANH until he dies naturally. He was in court today to hear the arguments for overturning the ruling which he believes will save him from death by starvation or deydration.
