title: Angels of mercy? The legal and professional implications of withdrawal of life-sustaining treatment by nurses in England and Wales.
abstract: In circumstances where life-sustaining treatment appears merely to be drawing out the inevitable, it is usual practice for the healthcare team to withdraw aggressive life-sustaining measures, once agreement is reached with the patient and their family. Common law gives doctors several defences to allegations of criminality or malpractice in taking the key actions that withdraw treatment and result in the patient's death; however, the legal defensibility of nurses undertaking this role has not been explored. In the absence of a specific body of law related to nurses taking the actions that withdraw life-sustaining treatment, I discuss the probable legal response by considering parallel cases. Examining some of the circumstances in which doctors are allowed to take life, I argue that the legal dispensation by which doctors are permitted to perform these tasks rests largely on their identity as doctors rather than any distinctive feature of their activities themselves. This uniqueness means that medical law for nurses is quite distinct from that for doctors. While it may nevertheless give nurses practical exemption from the legal consequences of their actions in withdrawal, it depends upon a judicial view that nurses are instruments of doctors. This judicial position is at odds with nurses' professional responsibilities, which envisage them as independent professionals who are liable for their own actions, inviting potentially adverse consequences from their professional registrar.
authors.affiliation: Centre for Ethics in Medicine, University of Bristol, Canynge Hall, 39 Whatley Road, Bristol BS8 2PS, UK. giles.birchley@bristol.ac.uk
authors.forename: Giles
authors.initials: G
authors.lastname: Birchley
mesh_terms: D003657:Decision Making; D004739:England; D006801:Humans; D033183:Interdisciplinary Communication; D024802:Nurse's Role; D013727:Terminal Care; D014852:Wales; D028761:Withholding Treatment / Q000941:ethics* / Q000331:legislation & jurisprudence*