86.Memorandum from Dr Darach Corvin (MIB
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:
(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
4. I would ask you to bear these above thoughts
in mind when you make your deliberations.