My heros: Muslim doctors who refuse to starve patients to death

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DAILY MAIL (London)

26 September 2007

By Jill Parkin

None of us likes to imagine such a terrible fate, but this much I do know: If I am ever in a coma I would like to be treated by Muslim or Catholic doctors, because if they're in charge, at least I know I will not be starved to death.

How extraordinary to think that in doing so - in the simple act of keeping me alive - they could be breaking the law.

From the beginning of October, the Mental Capacity Act comes into force, making criminals out of doctors if they insist on feeding coma patients who have earlier said they'd rather die.

It will be a black Monday for healthcare in the UK.

The only glimmer of hope is that the Islamic Medical Association has now followed the Catholic Church's earlier response in saying that its doctors should break the law, rather than enact so-called 'living wills', in which patients have - at some point in their past - left written instructions requesting that doctors should allow them to die if they suffer a medical condition that appears beyond recovery.

It seems to me that Muslims have got this one right, and I'd certainly rather be in their hands than in those of a lawabiding medic waving a bit of paper which I had once signed when feeling a bit low.

I want someone to be in charge of my feeding tube who is wiser than I was then.

If he thinks he gets that wisdom from a hotline to the Almighty, so be it.

For once, the dogma and the ideology is coming not from the world's faiths, but from rationalists such as the British Medical Association and the British Humanist Association who have actively campaigned for living wills to be made legal.

They both support the new act, which not only allows patients to instruct doctors not to try to save them but also allows patients to give powers to a relative or friends to instruct doctors to starve such a patient to death.

'Doctors' own religious convictions should never be allowed interfere with patients' rights,' says the British Humanist Association.

I have a lot of time for the BHA normally.

But in this case they are falling into the same trap as the religion-bashing scientist Professor Richard Dawkins.

They are so keen to denigrate and dismiss religion that they don't always see the humanity underlying it.

For a start, there have been several cases where coma patients have been written off and have woken up again.

It happened to the sister of a neighbour of mine. She lived a rewarding and able life in her own home for several years after 'waking up'.

Yet when she was in the depths of her coma, her siblings had even reached the point of voting on whether or not to turn off the life support machine - an agony for all.

Thank God they had no 'starve me' instructions to follow.

Then there is the ethical question of how many of us would want the responsibility of refusing food and drink for someone, of not knowing - because the patient cannot tell us - what pain and bewilderment that might cause?

Apart from the fact we cannot know how the patient feels or whether they might recover, there's the problem that we all change our minds.

It's one thing to sit on the parapet with your legs over the edge staring into oblivion, as a young man did on a high building near our house for several hours the other day.

It's quite another - as he did not - to jump to your death.

Yet under the Mental Capacity Act, you may well have your beloved daughter or nephew creeping up behind you and giving you a metaphorical big push - after all, there may be a lot of money in your will.

We don't always know best, and we don't always know how we will respond in any situation,especially when it comes to anticipating the medical treatment we need: ask any woman who has written a birth plan in the months before labour.

If I'd been able to move at the time I'd have made a bonfire out of my 'no intervention' plan about a quarter of the way through giving birth to my first child.

Midwives have seen it over and over again.

"She says here she doesn't want pain relief whatever she says at the time," protests the husband while the mother-to-be can't decide which to do first: impale herself on the epidural needle or brain the father-to-be with the gas and air cylinder.

In such cases it's the role of those who govern us to be wise on our behalf.

This isn't a religious 'life at all costs' argument.

I'd let babies go - those who are so disabled they will never know anything but pain.

But I wouldn't do it by starving, just by letting nature take its course, with help from pain relief.

I could no more starve my husband in a coma just because he once said I should than I could stop feeding a faddy toddler or offering food to a bulimic teenager.

It would be cruel, irresponsible and inhuman.

Where might it end? Faced with a difficult medical decision, might doctors not allow a living will and the arguments of a relative, even a well-meaning relative, to have undue weight?

What about inconvenient older relatives not sure about exactly what they are signing?

Wills which deal with houses and inheritances can be contested in a court, but the coma patient has no such recourse.

Can it be right that we can appeal to a judge to reverse Aunt Ethel's bequest to her budgie and yet we can set up a system which can starve us because we once signed a bit of paper?

Of course the health service is over-burdened and coma cases cost money.

But in a civilised society there are many, many times we have to risk wasting money, whether it's on healthcare for people who will never eat sensibly, lifelong prison for people whom we no longer hang, or post-14 education for reluctant pupils.

Fairness and humanity don't come cheap.

The Mental Capacity Act came into being partly because of the case of Tony Bland, crushed in the Hillsborough disaster in 1989.

The House of Lords ruled in 1993 that doctors could end his life. It led to tube feeding being called a treatment rather than a necessity.

It was the thin edge of the wedge, but at least the decision was made transparently by independent individuals. Would it not be fairer if all such cases could individually go to such a higher authority, rather than be subject to the sweeping edict of the new Act?

It would not be a perfect answer and it would not be as cheap, but at least this matter of life and death would be lifted out of the emotional realm of friends, relatives, and bits of paper signed in the days we felt low or incapable of ever accepting diminished quality of life.

And surely even in our dehumanised irreligious age, the old belief - central to most religions - that life is sacred cannot be lightly dismissed.

That is why we should beware these science-is-god rationalists, just as much as we should beware religious fundamentalists. They all too easily dismiss what they don't like as ' paternalism', or 'religious fanaticism'.

It's a way of twisting usually liberal rhetoric and using it against genuinely liberal and humane thought.

This week it has taken an Islamic group to point out where true humanity lies: not in extremes but alongside the recognition of doubt and of human frailty.

What a sad day it will be next week when we outlaw all those doctors of faith or no faith who have our best interests at heart, who indeed - in a sense that the rationalist wing may not quite understand - actually do have a heart.