Posted by: Witch Doctor | October 21, 2009

What are doctors for?

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What happened in Norwich in the Kerry Wooltorton suicide case concerns me a great deal as a doctor, but it concerns me even more as a patient or as the relative of a patient.

There is a conversation going on at a BMA website just now about this. I was going to post the comment in full below, but it would have been too long so I have posted  here and the comments section in the BMA post should pick it up as a track-back.

It does not require membership of the BMA or a password to access the the original post and the discussion. I have closed comments here so that if there are any, they can take place at the site of the original post.

COMMENT:

A doctor’s clinical role is normally to diagnose with a view to saving life and make it as comfortable as possible for the patient. That is his job almost all of the time. Occasionally it may be his job to let a life go, but that is not the norm. The way to let a life go may be by a deliberate act of doing nothing. Before a doctor deviates from his normal role of saving life, i.e. what he was trained to do, and what is expected of him, there has to be a definite, carefully considered decision made taking many aspects into account. These aspects will be unique to the patient and the situation. The decision may lead to the act of ensuring the patient is comfortable, but otherwise the act may be one of masterly inactivity.

And yes, when the patient dies, the doctor is complicit in the death. How can he not be?

It was however, an act.  He behaved in a specified way, contrary to the norm, following a decision.  The doctor was not a passer-by who didn’t quite notice something was amiss or did not have the confidence to intervene or was in a hurry somewhere. The doctor was in charge and responsible for the patient’s management. It was a decision, an act, a behavior to allow death because the doctor knows how to save life. And that is his normal role.

Quote from the comment on The BMJ Group –Journal of Medical Ethics Blog October 21 2009 at 9.59am:

“In the Wooltorton case, I’m not sure that there was anything too blameable about not intervening.”

I agree. But note the word “too” before “blameable.”

It is the “I am not sure” that is important. Uncertainly is rife in medicine. It is that kind of job. You have to live with the consequences of making a wrong decision and often there are several possible decisions. Consultants are paid a lot of money to make difficult decisions. However, if you are “not sure” life will take precedence over death. To make a decision to end life rather than save it when you are unsure is not the way to practice medicine. It is as simple as that.

It seems the problem was that the consultant who was looking after KW, sought advice.  He sought advice because he was unsure.  But who could be sure? It was always going to be a decision that dealt with an uncertainty. In seeking advice, he likely set off a chain reaction which eventually put the problem into the hands of lawyers who tossed about words and ideas and difficult interpretations so much that they forgot to draw the legal link between the Mental Capacity Act and The Suicide Act. At least, that is how it seems to me and to several other members of the medical profession.

It also seems that lawyers and ethics committees need to get their heads together again soon, because what has happened in Norwich has set a legal precedent that is at odds with the code of practice of most doctors. Indeed, most doctors that I know, placed in similar circumstances would break the law as it now stands.

What is to be done when that happens?”

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