THE National Health Service should not have to give life- prolonging treatment to every patient who demands it because that would mean a crippling waste of resources, the Government said yesterday.

A lawyer for Patricia Hewitt, the Health Secretary, said that a ruling granting a patient the right to request life-prolonging care had serious implications for the NHS.

The dramatic intervention came as lawyers for the General Medical Council challenged a High Court ruling that supported a terminally-ill man’s wish to be kept alive artificially.

Leslie Burke, 45, who suffers from cerebellar ataxia, a degenerative brain condition, won a landmark case last May granting him the right to stop doctors withdrawing artificial nutrition or hydration (ANH) treatment until he dies naturally.

The Department of Health, backing the GMC’s attempt to reverse the ruling, said that if that right were established, patients could demand other life-prolonging treatments. The department argues that this will create a culture in which patients request treatments “no matter how untested, inappropriate or expensive, regardless of doctors’ views”.

Philip Sales, for the Health Secretary, told a panel of three appeal judges, headed by the Master of the Rolls, Lord Phillips of Worth Matravers: “A general right, as identified (in the High Court), for an individual patient to require life- prolonging treatment has very serious implications for the functioning of the NHS.

“It may be interpreted as giving patients the right to demand certain treatments, contrary to the considered judgment of their medical team, that would lead to patients obtaining access to treatment that is not appropriate for them, and to unfairly skewed use of resources within the NHS.”

Under current GMC guidelines, a competent patient could decide between treatment options offered by a doctor. “But the patient cannot require his doctor to offer him any treatment option which, in the doctor’s view, is not clinically appropriate or which cannot be offered for other reasons — having regard to the efficient allocation of resources.”

Mr Sales said that the ruling had led to a confusion of the roles of doctor and patient — decisions over treatment were for doctors, not patients.

Doctors’ leaders said the precedent won by Mr Burke had created a minefield of unresolved issues over appropriate treatment and use of NHS resources. The GMC’s arguments — that the ruling is unclear and puts doctors in an “impossibly difficult position” of having to pursue treatments of no clinical benefit — has widespread support within healthcare.

Intensive care beds, where patients can receive lifesaving care such as ANH, cost £1,500 a day to run while high-dependency beds for patients who require close monitoring cost up to £800 a day.

The Government put £300 million into critical care beds after the flu epidemic of 1999-2000, increasing the number of intensive care beds from 1,496 to 1,677 and high- dependency beds from 847 to 1,208. by January 2001.

But since then the number of high-dependency beds has risen by only 206, the Intensive Care Society says. Figures from 2000 revealed that the NHS had four critical-care beds per 100,000 — compared with 25 in Germany and 24 in the US. No figures are available on how many patients in Britain are in long-term intensive care.

Mr Justice Munby ruled last year that if a patient is competent, or has made a request before becoming incompetent, doctors have a duty to provide ANH. Mr Burke, from Lancaster, was in court in his wheelchair yesterday listening to the arguments for overturning the ruling, which he believes will save him if ANH was withdrawn after he loses the ability to communicate. Richard Gordon, QC, for Mr Burke, argued that the GMC case was based upon a misunderstanding of the role of doctors in relation to the legally competent patient. The hearing continues.

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