Medical Ethics and Law – Withdrawal of Treatment

This new series in this GradReady blog will look at some aspects of medical ethics and law that will both be common considerations in medical practice, and also strong preparation material for entering medical school. It is extremely useful to be aware of common ethical/legal situations facing doctors, and to have an idea about the debate that surrounds these issues. The GAMSAT® Exam may once in a while throw up an essay question, or have a few section 1 questions, that relate(s) to an aspect of medical ethics; whilst the interview into medical school will commonly include some kind of ethicolegal problem solving and deliberation. Although this blog series will outline aspects of these medical ethical-legal tensions, it is always important to be balanced in any consideration you give when answering these types of questions. Always give consideration to both sides of the debate, and don’t rush into a conclusion – especially as there is often not always just one ‘right’ answer. An excellent illustration of the ethical and legal debates surrounding the withdrawal of life support is provided by the recent case of Cairns and Hinterland Hospital and Health Service v JT by JT’s Guardian (2014). This case concerned a 37 year old diabetic father of two (‘JT’) who suffered a cardiopulmonary arrest whilst away from home from work, which developed into a diabetic ketoacidosis coma. The hospital staff at the time were able to save his life, but he has languished in care for a year since.

 

Over that year in care, JT has been in what has been determined as a ‘persistent vegetative state’. This means he has not responded meaningfully to any stimuli, does not recognise anyone, and the most movement he is able to do is follow very bright objects with his eyes. This legal case (‘Cairns v JT’) also involves his wife as JT’s guardian, who is a party to the proceedings by formality only, and is not aversive to the orders proposed. These orders are proposed by the Cairns Hospital, which are to withdraw his life support, stop artificial hydration and feeding, and cease insulin administration. It is estimated that he would then die within 48hrs.

 

The concern from the medical profession for these types of cases, the withdrawal of life support, is that it appears fundamentally antagonistic to the duty to care for and help the patient. Further, withdrawing life-sustaining measures might give rise to criminal responsibility. However, the fundamental question in these cases is whether it would be in the patient’s best interests. As the patient cannot make the decision for himself, the court invokes jurisdiction to make orders in their best interests (‘parens patriae jurisdiction’), having regard to their prognosis, wishes of their family, as well as their previously stated attitudes or requests concerning such a course. If treatment is not in the patients best interests, the court would not be able to give its consent on his behalf and it would follow that, since it would then be unlawful to give such treatment, its with holding or withdrawal would be lawful and not in breach of any duty towards the patient. Indeed, in this particular case with JT, he also had expressed wishes prior to his accident that he never wanted to ‘end up as a vegetable’.

 

Based on these views and the overwhelming medical evidence holding no future improvement for JT, the Judge in this case consented to have his life support discontinued. These cases are fascinating not just because hey almost go directly against traditional notions of the doctor as a ‘healer’, but also because it is antagonistic to deotonological notions of the life as being absolutely sacred, and killing always being an evil.

Check out our GAMSAT To Med School Podcast for more interesting news, tips & tricks about the GAMSAT, applying to medical school, and life at med school.