Clinically Assisted Nutrition and Hydration: New guidance for doctors

Following a Supreme Court decision in July 2018 which confirmed that judicial approval is not always needed when withdrawing life-prolonging treatments from individuals with a prolonged disorder of consciousness (PDOC), such as minimally-conscious or persistent vegetative state, the British Medical Association and the Royal College of Physicians have developed new guidance which is published today. The guidance advises doctors when they’re making decisions about providing or not providing life-sustaining nutrition and hydration via feeding tubes for adults who have lost the ability to decide for themselves.

Compassion in Dying is working to change the conversation around death and dying so that end-of-life care is person-led, and so we welcome this new guidance which clearly places the person at the centre of their care. Through our free Information Line and our community outreach work, we hear from people who have strong feelings about CANH and want to plan ahead to ensure these wishes can be known and followed by healthcare professionals. We also get calls from people concerned that their or their loved ones’ end-of-life wishes may not be respected.

This new guidance will be immensely helpful in clarifying how people can plan ahead for their end-of-life care and how families and healthcare professionals can ensure they are making the right decision for each individual, even when it is a difficult one. The explanations on how to make legally binding care plans through Advance Decisions to Refuse Treatment and Lasting Powers of Attorney for Health and Welfare; on the importance of keeping the patient at the centre of decision-making; on conscientious objection and the responsibilities that go alongside it; and on the value of external reporting and audits make these guidelines particularly comprehensive and useful.

We are also pleased to have contributed to the guide for families, which recognises that family members need support with end-of-life decision-making and that doctors should provide clear information to help them.

We hope that this guidance will help avoid more tragic cases like those of Mr Y, Paul Briggs and Mrs M, where people sadly did not record their wishes for future treatment and care before becoming seriously unwell and unable to say what they wanted. No one plans to have an accident or become unwell – but there are things you can do now to help ensure that your wishes can be known about and followed in case tragedy does strike. Free, specialist information on how to plan ahead and record your wishes is available to all via Compassion in Dying’s Information Line (0800 999 2434) and website.