Surgeons have a moral right not to prevent the death of a brain-damaged patient destined to live a "demonstrably awful life". However, the final decision should only be taken by the consultant in charge, according to guidelines from a working party of surgeons published yesterday. The "duty of care" ethical and legal guidelines from the Senate of Surgery of Great Britain and Ireland details situations where it is permissible for life-saving or life-preserving treatment to be withdrawn.
It says such treatment does not have to be given to adults or children who cannot think for themselves where such action is believed by the clinical team, in consultation with relatives, to be in the patient's best interests.
The president of the Irish Medical Organisation, Dr Neil Brennan, yesterday welcomed the publication.
He said it would be examined carefully by the organisation's ethics committee in relation to medical practice in the State. He saw the moral right not to prevent the death of a brain-damaged patient "as a right not a duty. The surgeon has a right to look at the situation critically". Three situations were listed where no treatment, possibly leading to the patient's death, could be considered.
One was where doctors agreed further treatment was futile and would not save the patient. The second was where the patient was "irreversibly and imminently close to death" and treatment would not improve his or her condition.
The third, and most controversial, was where a patient had "devastating and permanent neurological injury which is so incompatible with any form of conscious self-directed activity as to count, in the circumstances of the patient, as a demonstrably awful life".
In this case there was "sufficient potential moral and legal debate" to require the final decision to withhold life-saving treatment only to be made by the chief consultant, who may wish to take legal advice.
"This third point is obviously more problematical, as we saw in the right-to-die case in this country involving the issue of artificial feeding and permanent vegetative state.
"It seems appropriate that a series of processes need to be gone through before a decision is made," said Dr Brennan. The guidelines point out that active euthanasia - a clinical choice directed at killing the patient - is illegal in Britain and Ireland.
But they say surgeons should respect the "living will" wishes of patients who ask that specific treatments should not be given for particular conditions, such as irreversible brain damage.
Properly formulated living wills could forbid their use, as well as other life-saving treatments. At present artificial feeding should only be withdrawn after the hospital management has been informed and after an appropriate court ruling, say the guidelines.
Dr Brennan said the issue of living wills "badly needed to be sorted out".
"As I understand it, living wills do not carry any legal weight here. But I think they are a good idea. It should be set up on a clearly defined legal basis. It is a reasonable thing, which can be looked at like someone carrying an organ donor card, if someone expressed a wish not to kept in a permanent vegetative state."
--(Additional reporting by PA)