Joint Committee on the Draft Mental Incapacity Bill Written Evidence

86.Memorandum from Dr Darach Corvin (MIB 791)

  1.  I am a medical practitioner of 32 years standing, having spent the past eight years in hospital practice and the last 24 years in full time general practice. Throughout all my years of practice I have dealt with chronic illness, terminal illness and death on an almost daily basis.

  2.  The withholding or withdrawal of fluids and food from an ill patient is a not uncommon event. It is invariably a decision made between relatives and medical staff concerning a terminally ill patient where the administration of food and fluids is either too distressing or dangerous for the patient, or where its administration would unnecessarily prolong a fading life. This is good medical practice and is in the patient's best interest. The words "ill" and "terminally ill" are precise and critical to the principal that guide this practice.

  On a practical level, I have never come across a situation where relatives or staff decide to withhold or withdraw food and fluids from someone who is:

    (a)  not ill;

    (b)  not terminally ill with a hopeless prognosis;

    (c)  likely to suffer distress as a result of withholding or withdrawing food and fluids.

  The thought of withholding fluids and food from such an incapacitated patient with the deliberate intention to end life would horrify me and the vast majority of medical staff. To be fed and hydrated have always been accepted as much a part of humane nursing care as physical hygiene, comfort and the relief of suffering. Food and fluid are not medical therapy.

  3.  I would like to comment on legally binding "living wills". If an unqualified and unaccountable attorney were to try and force me to bill my patient by withdrawing or withholding fluid and food, and if I thought that this was not in the patient's best interest, I would simply refuse and risk the consequences. I cannot think of anything more likely to undermine and corrupt medical staff than the withholding of nutrition and where there is a medico-legal threat forcing them to act against their best judgements. These practices would totally undermine the work of the staff in the field of palliative care and greatly affect the patient-doctor relationship.

  Anyone who has any knowledge of the medical profession is aware of how subtle pressures can degrade the practice of medicine at a very basic level. Patients are rightly worried when they feel that their doctor may not be acting in their best interests. This was very keenly felt at the time of GP fundholding in the 1990s and had a significant negative impact on the doctor-patient relationship.

  4.  I would ask you to bear these above thoughts in mind when you make your deliberations.

August 2003

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