A judge’s ruling hailed as a breakthrough for the rights of terminally-ill patients could put doctors in an impossibly difficult position, the Court of Appeal was told today.

Leslie Burke, a 45-year-old former postman who has a degenerative brain condition, won the right last year to stop doctors withdrawing treatment when his illness reaches its final stages.

Mr Justice Munby said in May last year at the High Court in London that if a patient is competent - or, if incompetent, has made an advance request for treatment - doctors have a duty to provide artificial nutrition or hydration (ANH).

Philip Havers QC, representing the General Medical Council, told three appeal judges headed by the Master of the Rolls, Lord Phillips: "In other words, the doctor must provide the treatment which the patient demands notwithstanding that the doctor’s clear professional view is that the treatment will provide the patient with no clinical benefit or will be futile."

He said that this was not the law - a patient did not have a right to require the provision of any particular form of treatment. Mr Burke, of Newton Estate, Lancaster, sat in court in his wheelchair as Mr Havers explained why the GMC wanted the court to overturn Mr Justice Munby’s ruling.

Mr Havers said the main purpose of the GMC was to "protect, promote and maintain" the health of the public, including those who need life-prolonging treatment. To further this end, the GMC had issued guidance to doctors - but Mr Justice Munby’s ruling, which extends "patient autonomy", would fundamentally alter the nature of doctor/patient relationships.

He said the conclusion of the judgment was not in the best interests of patients because, firstly, doctors would have to provide treatment which they knew would be of no benefit or could even be harmful. Secondly, to require a doctor to do so was destructive of the relationship between doctors and patients.

Finally, such a conclusion "puts the doctor in an impossibly difficult position, for a doctor should never be required to provide a particular form of treatment to a patient which he does not consider to be clinically appropriate", said Mr Havers.

"Doctors are under a professional duty not to provide such treatments to patients."

Mr Burke took the GMC to court because he feared that his wish to go on living until he dies naturally could be overridden under current GMC guidelines.

Mr Justice Munby said that although the bulk of the guidelines were in place to reassure patients and relatives, he took issue with them "in a limited number of respects", and ruled parts of them unlawful.

Lawyers representing Mr Burke claimed the judgment represented a shift in the balance of power away from the doctor to the patient, and from the medical profession to the courts.

Mr Burke suffers from degenerative cerebellar ataxia, an umbrella term for nervous system disorders that cause a lack of coordination. He brought the case, arguing that GMC guidelines were incompatible with the European Convention on Human Rights, because he feared reaching the point where he would be denied food and water.

Speaking before today's hearing, Mr Burke said the GMC guidance might mean that doctors would stop feeding him once he was unable to communicate. If that happened, it could take him days or weeks to die - during which time he would be fully aware of what was going on.

"That is not a dignified way to go," he said.

The case has become an international controversy. Among those throwing their weight behind Mr Burke was Wesley Smith, a senior US lawyer who advised the family of Terri Schiavo, the brain-damaged Florida woman who died in March after her feeding tube was withdrawn.

Mr Smith said: "Leslie Burke knows what he wants. If he loses this case... doctors are saying to elderly and disabled people, 'If you want to live, it's not up to you."

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