Drs shouldn’t need court approval to do no harm

“How aggressive do you want us to be in treating Tom?” the doctor asked.

He was referring to our baby who had a degenerative brains disorder, had stopped breathing, been revived and taken to hospital.

We said that if he was fighting for himself he should be helped but if it came down to using technology to prolong the inevitable he should be left alone.

A few hours later another doctor asked the same question and I gave the same answer. Tom died a few minutes later, in my arms.

Nearly seven years later Tom’s brother Dan stopped breathing. The registrar treating him asked the nurse to get the crash team but I said “no”.

The paediatrician in charge of Dan’s care had discussed this situation with us when he was only a few weeks old and it was obvious he had the same condition which had killed Tom. The consultant’s advice was that if something life threatening happened, Dan shouldn’t be treated.

I explained this to the registrar who asked me if I was sure. I said “yes,” and he said, “I think that’s the right decision.”

That was 17 years ago tomorrow and I thought that this sort of  situatio, while not common-place, wouldn’t be unusual. Life is fatal and not treating someone who is terminally ill can sometimes be the best way of doing no harm.

I thought that was accepted practice.  But just a couple of weeks ago a special court was convened at night to determine whether a health board’s decision not to do surgery on a terminally ill boy would amount to homicide.

A judge ruled it did not, finding it was in accordance with “good medical practice” not to do the life-prolonging operation. The seven-year-old boy died the next day.

This sort of decision shouldn’t be taken lightly but I don’t understand why there was a need to take it to court. As Dr Richard McGrarth says at Not PC:

 I find it disturbing that a court should even be considering whether they can force a surgeon to operate on anyone, or charge him with homicide if he declines to operate and the patient then dies of natural causes.

I have no doubts that not treating my sons was the right thing to do.

If I was in a similar position with a similar prognosis I’d make the same decision again and I’d be very upset if I had to go to court to protect the doctors I was asking to withhold treatment.

Doctors shouldn’t need a judge’s approval to do nothing when that is the best way to do no harm.

8 Responses to Drs shouldn’t need court approval to do no harm

  1. I don’t blame the doctors, given that serious cases of medical negligence can lead to manslaughter charges it must be helpful to got heavyweight legal signoff in advance.

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  2. gravedodger says:

    My thoughts, and those, I am certain all of us who graze in the ‘Homepaddock’ are with Ele and her farmer as another anniversary of what is, imo one of the cruelest hurdles of life, watching your child pass and be powerless to save it. I for one am grateful that you show the courage to share openly the loss of Dan and Tom. It is inspirational.

    It is often heard, as medical treatments go way beyond healing, restoration and relief of suffering into the realm of prolonging life, in many cases just because we can, leaving Drs and other health providers exposed to what G E mentions above as another facet to be considered in their clinical decision making. IMHO those delivering health service need more protection for what are in effect rational, logical and sensible decisions without the sort of repercussions Graeme mentions hanging over them. We are not talking gross negligence or even common garden negligence but decisions that are reached in the light of the evidence, nearly always in consultation with family and colleagues.

    It has recently come into my orbit of knowledge that a severe stroke (CVA) in a Pt over 85 will in most cases not be treated with the drugs for “clot dissolving”, also the terminally ill are not for ED but if requiring treatment in the end stage of life then treat at home of if necessary they be taken to a Hospice. These measures could be seen as “rationing” whereas to an old farmer who has spent a working life playing god, I see them as just reasonable practical steps in delivering the achievable in the real world of finite resources.

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  3. alex Masterley says:

    HP your courage in the face of the adversity you have faced is amazing.

    The problem is that medical practitioners have one eye on the patient and one eye on the health and disabilities commissioner whose raison d’etre seems to be to second guess clinical decisions (at least to my jaundiced eye) when outcomes aren’t what was expected by the patient and that patients relatives.

    As an aside, my son spent 4 nights in starship with a compound fracture this past week.

    What astonished me was the pile of paper that stay generated from begining to end and the need for consents for everything.

    It was mind bending.

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  4. Inventory2 says:

    Thoughts, prayers and aroha are with you as another sad anniversary passes Ele.

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  5. Paranormal says:

    Ele, Gravedodger and co have said it far more eloquently than I can. I stand with hat off and head bowed in respect.

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  6. MacDoctor says:

    My thoughts and prayers with you tomorrow, Ele.

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  7. Farmer Baby Boomer says:

    As one who has walked a somewhat similar path my thoughts and prayers are with you HP.

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  8. homepaddock says:

    Graeme – that’s a sad reflection on society if court orders are now necessary to protect doctors in such cases.

    Thanks for the kind thoughts. Few if any of us go through life untouched by sadness but the real tragedy is if you let it ruin your life.

    Tomorrow is also a niece’s birthday so it is a happy anniversary too.

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