Letter to CMF Members regarding BMA guideline on CANH

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RE: Clinically-assisted nutrition and hydration (CANH) and adults who lack the capacity to consent

We are taking the unusual step of writing to members, asking you to consider contacting The British Medical Association (BMA) to express serious concern over the draft guidance for health professionals on decisions about clinically-assisted nutrition and hydration (CANH) that they have drawn up with the Royal College of Physicians (RCP) and the General Medical Council (GMC).

The BMA conducted a consultation on the draft guidance that closed on 8 August; CMF's submission can be read here. The consultation period concluded just as the judgment of the Supreme Court in NHS Trust v Y ruled that an application to the Court of Protection (CoP) for permission to withdraw CANH from a patient lacking capacity is no longer required, where doctors and relatives agree that it would be in the patient's 'best interests'.

The BMA's draft new guidance would enable doctors to dehydrate and sedate to death large numbers of non-imminently dying patients with dementia, stroke, Parkinson's, permanent vegetative state (PVS) and minimally conscious state (MCS) (see here and here).

At the same time, a report from the American Academy of Neurology updating their own guideline for managing prolonged disorders of consciousness was published, and contains some startling conclusions that are highly relevant to the BMA consultation, specifically:

• Four in ten people who are thought to be unconscious are actually aware

• One in five people with severe brain injury from trauma will recover to the point that they can live at home and care for themselves without help

• The term PVS should be dropped in favour of CVS (chronic vegetative state) and pain relief should be given to patients affected

We believe the new BMA guidance fails adequately to recognise the complexity and difficulty of diagnosis and prognosis, removes safeguards that, for all its shortcomings, the practice of referral to the CoP provided, and essentially enables euthanasia 'by stealth'.

To cap it all, the guidance instructs doctors to in effect falsify the death certificate, recording the death as due to the underlying condition (from which a patient would not have died in the time-frame) rather than as a result of dehydration and sedation.

The new guidance is due in October so please consider contacting Ruth Campbell, Senior Policy Advisor (Ethics) at the BMA in the next couple of weeks, copying your email/letter to the GMC and to any Royal College of which you are a member. One well-aimed stone was all it took to bring down Goliath!

Warm regards

Dr Rick Thomas on behalf of CMF Public Policy team.