http://bmj.com/cgi/content/full/323/7326/0

BMJ 2001;323 ( 15 December )

Editor's choice

The edges of doctoring: the law's view

If health is complete physical, mental, and social (and why not spiritual?) well being and health is the province of doctors, then doctors should surely be running everything. This is an idea that is probably more terrifying to doctors than to the population at large, but where are the limits of medicine? A theme issue next March will explore this topic (contributions still welcome), but several news stories in this issue illustrate legal thinking on where legitimate doctoring ends.

Doctors in the Netherlands are allowed to kill patients with "suffering of a medical nature" if they request euthanasia (p 1384). The law in most other countries declares this illegal. So the Dutch have extended the edges of doctoring. But a court in the Netherlands has now decided that doctors cannot accede to requests for euthanasia from patients with "existential" suffering"often associated with ageing, resulting from loneliness, emptiness, and fear of further decline." Many doctors may think that they spend more time managing existential suffering than they do conditions that fit neatly into medical textbooks, and a galaxy of philosophers might have trouble separating the two forms of suffering to the satisfaction of all. The Royal Dutch Medical Association is considering the "tired of life" question, creating, I can't help thinking, a marvellous subject for Rembrandt.

Meanwhile, France's highest court of appeal has upheld the award of damages to a boy for "being born" (p 1384). The boy had Down's syndrome, and his mother was not offered amniocentesis. If she had been, the abnormality would probably have been detectedand she would have opted for an abortion. Some doctors say that they are now being held to a standard of being 100% correct in predicting malformations. Disabled people demonstrated outside the court, protesting that the decision showed contempt for them. A French professor and parliamentarian thinks that the court's decision is ethically and judicially wrong because there is no direct link between the possible fault of the doctor and the Down's syndrome and because it is absurd to compensate somebody for being born. Is French law saying that doctors must offer every test to everybody who might possibly benefit?

In Britain, the Privy Council has overturned a decision of the General Medical Council to strike from the register a doctor who pleaded guilty to five charges of false accounting (p 1385). By doing so, the Privy Council finds that it is not completely unacceptable for doctors to be dishonest. Lawyers interestingly cannot be dishonest and continue to practise. Is it right that doctors should be held to a lower standard than lawyers? Would you be happy to be treated by a dishonest doctor? Trust, after all, is either present or absent.

Footnotes

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© BMJ 2001

Other related articles in BMJ:

NEWS
"Existential" suffering not a justification for euthanasia.

Tony Sheldon
BMJ 2001 323: 1384. [Full text]  

NEWS
Highest French court awards compensation for "being born".

Alexander Dorozynski
BMJ 2001 323: 1384. [Full text]  

NEWS
Head of the Medical Council of India removed for corruption.

Rohit Sharma
BMJ 2001 323: 1385. [Full text]  

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