Joint Committee on the Draft Mental Incapacity Bill Written Evidence

48.Memorandum from Julia Goffin (MIB 21)

  I wish to make the following submission on the Draft Mental Incapacity Bill. My primary concern is that the Bill contains no amendment to outlaw the withdrawal of life-sustaining treatment and care with the purpose of causing death. There is no requirement of course to provide food and fluid in the rare cases where it causes distress to the patient.


  1.  On the subject of legally binding Advance Directives I can see several problems. When an individual signs an Advance Directive, he can have no idea what treatments may be possible or necessary. He can have no inkling of future cures. The circumstances prevailing at the time of implementation may be complex and unforeseeable.

  2.  Legally binding Advance Directives could lead to non-treatment of a curable illness. The patient could, due to legal restraints on treatment, end up in the very state they feared when signing the Advance Directive ie disabled (but unnecessarily so).

  3.  No one is required to check whether an individual was fully informed of the consequences of signing.

  4.  If a patient should become disabled because of failure to treat due to a binding Advance Directive, there will be no redress as the doctor is not exercising his own judgement.

  5.  The power to decide when the time has come for an Advance Directive to come into effect belongs with the doctor, as does the power to decide the type and extent of medical intervention that is to be withheld. This power is not restricted to "extraordinary care" but to any medical intervention.

  6.  A recent survey found that 71 per cent of doctors said there were circumstances in which they would wish to disregard Advance Directives.


  1.  The traditional interpretation of "best interests" has been "best clinical interests". The Draft Bill includes in "best interests" much wider and looser considerations such as "spiritual and religious welfare" and "financial interests" or what someone imagines the patient's interests might be. These are poorly defined, vague and subjective opinions.

  2.  According this re-writing of "best interests", an argument could be put forward that a patient's quality of life is believed to be so low that they do not warrant the protection of the law against homicide.


  1.  It is to be welcomed that the Draft Bill contains a clause that will not allow non-voluntary euthanasia by withdrawal of treatment regardless of the wishes of the patients or their families. However the extension of the current remit of the Enduring Power of Attorney into healthcare decisions could prove to be very dangerous. Appointed proxies would possess legally binding powers to force doctors to kill by withdrawing life-sustaining treatment and care. Such attorneys may be unqualified and would be unaccountable.

  2.  The Draft Bill includes no clause establishing a system of appeal to protect the rights of doctors who may feel pressured by self-interested proxies to withdraw food and fluids from mentally incapacitated patients.

  Whilst I would agree that many parts of the Draft Mental Incapacity Bill could prove very valuable, it also includes provision for euthanasia by neglect.

  I cannot understand why so little time has been allowed for evidence and submissions to be sent to the Standing Committee on these most controversial and wide-ranging proposals.

August 2003

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