Legal Constraints

In the UK, the withdrawal or withholding of medical treatment is governed by a complex interplay of legal constraints, the Mental Capacity Act 2005, and ethical principles. Here’s a detailed look at these aspects:

Legal Constraints

1. Common Law and Case Law:

• Airedale NHS Trust v Bland (1993): This landmark case established that life-sustaining treatment can be lawfully withdrawn if it is in the patient’s best interests.
• Re F (Mental Patient: Sterilisation) (1990): This case set out principles regarding the treatment of patients who lack capacity, focusing on the necessity and best interests.

2. Statutory Law:

• Human Rights Act 1998: Incorporates the European Convention on Human Rights into UK law. Relevant articles include:
  • Article 2: Right to life.
  • Article 3: Prohibition of torture (including inhumane or degrading treatment).
  • Article 8: Right to respect for private and family life.

3. Mental Capacity Act 2005 (MCA):

• This Act provides a framework for making decisions on behalf of individuals who lack the capacity to make particular decisions for themselves.

Mental Capacity Act 2005

In the UK, the key legal framework for withdrawal or withholding of treatment is the Mental Capacity Act (MCA) 2005. This Act applies to adults aged 16 and over who lack capacity to make decisions about their medical care.

The MCA outlines key principles and guidelines:

1. Presumption of Capacity:

• Every adult has the right to make their own decisions and must be assumed to have the capacity to do so unless proven otherwise.

2. Support to Make Decisions:

• Individuals should be given all practicable help before anyone concludes that they cannot make their own decisions.

3. Unwise Decisions:

• Just because an individual makes an unwise decision, they should not be treated as lacking capacity.

4. Best Interests:

• Any decision made, or action taken, on behalf of someone who lacks capacity must be done in their best interests.

5. Least Restrictive Option:

• Any decision or action taken should be the least restrictive of their basic rights and freedoms.

Ethical Principles

1. Autonomy:

• Respecting the patient’s right to make their own decisions. In cases where the patient lacks capacity, their previously expressed wishes, feelings, beliefs, and values should be considered.

2. Beneficence:

• Acting in the best interests of the patient by providing benefit and balancing the benefits of treatment against the risks and costs.

3. Non-Maleficence:

• Avoiding the causation of harm. This involves not only physical harm but also psychological harm.

4. Justice:

• Treating patients fairly and equitably, ensuring fair allocation of resources and respect for the law.

Application to Withdrawal or Withholding of Treatment

1. Assessment of Capacity:

• A thorough assessment must be carried out to determine if the patient has the capacity to make the decision regarding their treatment. This involves understanding the nature and consequences of the decision.

2. Advance Decisions and Lasting Power of Attorney (LPA):

• Legally binding advance decisions (also known as living wills) and LPAs allow individuals to state their preferences for treatment or appoint someone to make decisions on their behalf if they lose capacity.

3. Best Interests Decision-Making:

• When a patient lacks capacity, the healthcare team must make decisions based on the best interests of the patient, considering medical, emotional, and all other relevant factors.

4. Consultation with Family and Carers:

• Family members and carers should be consulted to gain insight into the patient’s wishes, feelings, and values, although the final decision rests with the healthcare professionals.

5. Ethics Committees:

• Complex or contentious decisions may be referred to hospital ethics committees for guidance and support.

6. Court Involvement:

• In cases of significant dispute or where the best course of action is unclear, applications can be made to the Court of Protection for a ruling.

Conclusion

The withdrawal or withholding of treatment in the UK involves a careful balance of legal obligations, adherence to the Mental Capacity Act, and ethical considerations. Decisions must prioritise the patient’s best interests, autonomy, and the principles of beneficence, non-maleficence, and justice, with appropriate consultation and, if necessary, legal intervention.