THE ruling by the High Court yesterday on end-of-life treatments will not resolve the dilemmas that doctors face. Specialists in geriatric medicine said yesterday that it had simply moved the goalposts.

“I welcome the clarification, but it still leaves a lot of things unclear,” Raymond Tallis, of Manchester University, said. “The judgment we will have to make is just as difficult as ever.”

The court ruled in favour of Les Burke, 44, who suffers from a degenerative disease, cerebellar ataxia, which means that eventually he will need to be artificially fed and hydrated.

The court ruled that if Mr Burke or anybody in a similar position demanded treatment, he was entitled to it, and that doctors could withdraw it only if the life it imposed on the patient was “intolerable”.

The ruling gives “living wills” — written when a patient is competent — greater authority over the treatment when mental incapacity intervenes. The great majority are made by patients who do not want to be resuscitated at the end of their lives. Demands to continue treatment have previously carried less weight but the court has now given equal value to both demands.

The ruling also raises the “threshold” at which doctors can withdraw or withhold treatment.

Previously, the decision has been based on an assessment of the “quality of life” of the patient; the High Court said yesterday that treatment should be withdrawn only if the patient would judge their life to be “intolerable”. The General Medical Council plans to appeal.

Professor Tallis said: “What do we do if treatment is clearly futile, and not in the best interests of a patient who cannot communicate, and where no clear document outlining his wishes exists? The judgment of what is intolerable is just as difficult.”

Dr Nadim Haboubi, a consultant geriatrician from Abergavenny, said: “How do you define intolerable? It’s like pain, it varies from one person to another. And I don’t think it is appropriate to lay down hard and fast rules. At the end of life, some judgment should be left to doctors. How can patients tell what condition they will be in 30 or 40 years in advance?” Dr Stuart Bruce, a consultant in the Department of Medicine for the Elderly at Conquest Hospital in Hastings, said: “If he (the judge) is saying that patients are entitled to demand treatments that are futile and burdensome, then it will mark a big change.”

In some conditions, such as persistent vegetative state, artificial feeding or hydration can keep patients alive indefinitely. In others, such as dementia or Huntington’s disease, death is inevitable but can be delayed. In yet others, such as stroke, there may be a chance that a patient will recover.

Professor Tallis said: “If the patient has a good prognosis, there is no problem. But if the prognosis is bad, then there is a problem. You have to try and second-guess what they would want.”

The High Court was told that the number of patients who die after the withdrawal of hydration and nutrition was “thousands”, but this is guesswork.

Julia Quenzler, of SOS-NHS Patients in Danger, said that many elderly patients with full mental capacity and the ability to eat and drink normally were sedated so that they were no longer competent; then hydration and sedation were removed on the grounds that the individuals were no longer able to make their own decisions.

In cerebellar ataxia, patients normally retain their faculties until the end, Dr Bruce said. So when the time comes Mr Burke will be able to make clear what he wants.

FOR AND AGAINST THE GMC GUIDELINES

A doctor should take legal advice about seeking a court ruling on any disagreement.

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