Persistent vegetative state, withdrawal of artificial nutrition and hydration, and the patient's "best interests".

Editorial Persistent vegetative state, withdrawal of artificial nutrition and hydration, and the patient's "best interests" In this issue of the journal Anthea Fenwick, an Edinburgh University graduate law student, robustly challenges the use of "best interests" by English judges in the context of permitting withdrawal of life-supporting nutrition and hydra-tion from patients in persistent vegetative state (PVS).' Judges, she states, have ruled that such life-sustaining treatment can be withdrawn on the grounds of the best interests of a patient in PVS; but this criterion ought to be rejected for four reasons: first, it is based on a "delusory objective": second its foundation is illogical; third, judicial interpretation of the criterion is excessively medically orientated, and fourth such "medicalisation" unduly narrows the acceptable range of potentially relevant interests when considering what are a patient's "best interests". From a perspective of medical ethics as distinct from medical law-and of course the two overlap-Ms Fenwick is surely being somewhat hard on the judges! They, like the medical profession are obliged to act within the law, both statutory and case law. For them, as for doctors, any intentional killing of another person who is not an aggressor is illegal and they are not permitted to change this fundamental legal fact, itself presumably established to uphold the literally vital general moral concern that people's lives should be protected. However, while intentional killing of non-aggressors is illegal, allowing others to die may be legally permissible and in some circumstances it is clearly right for a doctor not to try to prolong a patient's life, or to cease doing so. This moral fact is widely, probably universally, recognised in law, allowing doctors in some circumstances to withhold, and in some circumstances to withdraw, life-prolonging treatment (LPT). The justification of such withholding or withdrawing of LPT in medical ethics would most probably be that its provision would not benefit the patient. The primary moral purpose of medicine is to try to benefit people in health-related ways and this is incorporated into a doctor's moral and legal duty of care. Where an intervention is highly unlikely to provide such benefit to the person there is no medico-moral or legal obligation to provide it and withholding or withdrawing it does not infringe the doctor's duty of care. Furthermore where continuing provision of non-beneficial medical resources deprives others of benefit, there is at least a prima facie moral obligation to withhold …