22 - Withholding or withdrawing treatment in the seriously or terminally ill

Summary

The capacity to save lives through advances in treatments, especially the use of intensive care and life-support systems, is one of the ‘miracles of modern medicine’. However, these advances have created ethical and legal questions for the medical profession, legislators, the courts and the community. Some of these questions have been resolved by new legislation, for example the redefining of death to include brain death and the separate laws that give force to advance care directives. Other questions have been addressed by new ethical guidelines, for example in regard to the care of patients in post-coma unresponsiveness (previously known as the ‘vegetative state’). Further questions continue to confront the community, for example the ongoing debate about euthanasia. This chapter outlines the law and the professional and legal responsibilities of doctors in these areas, but does not enter into the wider social, ethical and philosophical debate surrounding euthanasia.

TREATMENT DECISIONS FOR NEWBORN INFANTS

Technological advances have created ethical dilemmas for parents and for doctors caring for extremely premature or severely malformed newborn infants [1–2]. In 1986 in F v F in the Supreme Court of Victoria, Mr Justice Vincent observed:

No parent, no doctor, no court, has any power to determine that the life of any child, however disabled that child may be, will be deliberately taken from it.

However, the law does recognise the responsibilities of parents, in conjunction with treating doctors, to decide whether medical intervention will commence or continue.