Unassisted suicide

What if a patient wants to die, and asks us to turn off the ventilator? Can we do this legally, even if we believe that it will cause his or her death, and life expectancy was otherwise normal?

There has not, as far as the author knows, been such a case in United Kingdom, although there was an analogous one. An insulin-dependent diabetic paraplegic wished to die, and withdrew consent for continued insulin. He died, and no criminal charges were brought. An individual of sound mind may refuse treatment for any or no reason. This applied to the diabetic, is regularly applied to Jehovah's Witnesses who refuse blood transfusion, and would probably apply to withdrawing ventilation. (This conclusion should not be taken to be applicable to children or those of unsound mind. Powers under the Mental Health Act may require continuation of physical treatment if the request to discontinue is a result of mental illness.) Manslaughter

Manslaughter is relevant to critical care in relation to gross negligence: if someone is killed as a result of really serious negligence, this may result in a charge of manslaughter. This has yet to happen in critical care, although there have been two recent cases of doctors charged with manslaughter, one an anesthetist's failure and the other a serious intrathecal drug error. It should be noted that a jury will decide whether there was gross negligence, advised by the judge and perhaps by medical experts.

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