Medical Ethics Alliance
Case before the Supreme Court from the appellants Nicklinson and another PDF Print E-mail
Written by E Fidan   
Tuesday, 08 July 2014 17:15
The Medical Ethics Alliance notes the press summary issued 25/6/14 in the case before the Supreme Court  from the appellants Nicklinson and another. 
"The Supreme Court unanimously held  that the question whether the present law on assisted suicide is incompatible with Article 8 ( of the  European Convention on Human Rights ), was within the United Kingdoms "margin of appreciation", and was therefore a question for the United Kingdom to decide, and that Parliament was inherently better qualified than  the Courts to assess, and that under present circumstances the courts should respect Parliament`s assessment"

 This is to be welcomed and the appellants did not succeed in their appeal that the Suicide Act 1961, was incompatible with their human rights.

The Medical ethics alliance says that once the principle of assisting suicide is granted it will be extended incrementally and that there are no effective safeguards against abuse and that attitudes towards vulnerable patients will change.

The Medical Ethics Alliance joins the British Medical Association, Royal Colleges of General Practice and Physicians, together with the British Geriatric Association and the Association of Palliative Care Medicine, in opposing physician assisted suicide.

further information can be obtained on 01886 853308
Response to L A C D P consultation PDF Print E-mail
Written by Dr A Cole   
Wednesday, 12 February 2014 20:45

The Medical Ethics Alliance

 Replacement of the Liverpool Care Pathway


The Medical Ethics Alliance is a coalition of six medical and nursing bodies and on 23rd June 1012 held a conference at the Royal Society of Medicine entitled, “Natural Death - is a pathway needed”(1) Subsequently we welcomed the review established under the chairmanship of Baroness Neuberger, and this paper is a response to the report “ More Care /Less Pathway”.We wish to comment on four of the recommendations made.

Recommendation 3

“The name Liverpool Care Pathway should be abandoned, and within the area of end of life care, the term “ pathway”, should be avoided, an “end of life care plan”, should be sufficient for both professionals and lay people”

(John could you please develop this area, especially the legal aspects)

( We should distinguish between advance statements which are advisory and advance refusals which can be binding if the circumstances that arise were those anticipated.

There are other questions about capacity.

There is a danger that a person can be locked into a bad decision which prevents them receiving help when they need it.

For example, if there is an obstruction of the bowel they may need relieving surgery)

We do not think that patients would welcome being put on a list of those considered tohave less than a year to live. Such a plan, which was recently advanced by Baroness Jolly in the House of Lords, (2)

 is likely to be seen as a “death list”. If financial incentives are also attached to it these could be misunderstood. In any event , such a prognosis will often be impossible or proved wrong .The case of Al Magrahiillustrates this and for many families the emotional difficulties would be insurmountable. Though no doubt well intentioned,those who make sucha proposal have probably not experienced the situation first hand.

Recommendation 5

“The National Institute for Health Research fund research into the biology of dying”.

There was a lack of evidence base for the Liverpool Care Pathway and such as did exist was entirely based on death from malignancy. We do not consider that to be adequate for an understanding of deaths from non malignant conditions. Following the Constantini paper in The Lancet (3),and Currow and Abernathey commentary (4), the need for proper randomised cluster controlled trials was evident. We consider this is essential, and note that Consantini has already indicated protocols for further research and it may be profitable for it to be conducted internationally.

Recommendation 8

“NHS England and Health Education England should collaborate to promote the use of prognostic tools, including awareness of their limitations…”

We suggest a repeat of earlier studies that compared the cause of death on death certificates with autopsy findings. The results could well be salutary and reveal treatable conditions for example, pulmonary embolus incorrectly diagnosed as pneumonia.

As a matter of good practice all doctors should ask themselves


1Just how secure is the diagnosis?


2Have all reversible conditions been addressed?


3Is the patient able to give informed consent to any actionproposed?


4Has the patient been given the information they seek? Has it beendone gently and honestly as it is so important for patients generallyto realise the reality of their situation and attend to their spiritualneeds. It may take a considerable time for some to reach thismoment. The “Five Stages of Grief”, have to be worked through.


Few patients wish to know their proximity to death and some cope by denying death until it can no longer be ignored. (5)


The M E Ahave suggested some questions which relatives may find helpful in discussions with doctors and nurses delivering end of life care. They are;


1Are you sure that death is imminent?


2Can the patient give consent to the treatment proposed?


3Will the treatment reduce consciousness?


4What effects will the treatment have, including the combinedeffects of the drugs proposed, and their effectiveness in reducingseverely troublesome symptoms?


5Will you assure that the patient will not experience thirst and canfluids be given by mouth or in another way?


6Will death be hastened by what is proposed? (6)



Recommendation 10


“The General Medical Council should review whether adequate education and training is currently provided at undergraduate and postgraduate levels to ensure competence. It should how … it can ensure that practising doctors maintain and improve their knowledge and skills in these areas”.


It will be necessary to improve the skills of senior doctors and general parishioners in palliative care. There are relatively few palliative care physicians and these are not available out of hours or at weekends. There is therefore a danger that protocols could be brought back rather than making management decisions based on the patient’sindividual needs. The watch word must be treatment should be based on need not prognosis.



We are firmly of the view that all persons should be treated with ethical, evidence based, compassionate and holistic care at the end of life.

Dr Anthony Cole




Mr J Duddington





(1)“Medical Ethics Alliance points towards good end of life care”,info medethics-alliance, 9/9/13,A Cole and 10 others

(2)Hansard reports on the House of Lords. Page 955 - 956, 12/12/12

(3)Constantini,“Liverpool Care Pathway for patients with cancer inhospital, a cluster randomised trial”, The Lancet 16th October,2013

(4)Currow and Abernathy, “Lessons from the Liverpool CarePathway”, The Lancet, 16th October, 2013

(5)Craig “CONSIDER; a mnenonic for care of the dying”, CatholicMedical Quarterly, Vol 63(4) November 2013, page 10

(6)Press release from Medical Ethics Alliance and Catholic medicalQuarterly , Vol 63(4)November 2013 , page 9

Last Updated on Tuesday, 08 July 2014 17:12
Welcome PDF Print E-mail
Written by Dr A Cole   
Friday, 13 November 2009 23:42

The Medical Ethics Alliance affirms the unique value of all human life, its God given dignity and consequent right to protection in law.

We are a non-profit organisation and have been established to promote pro-life policies.

We are certain that all persons are of inestimable worth, irrespective of illness or disability.

The pursuit and practice of medical excellence is dependant upon sound ethical principals.

The Alliance looks to the Declaration of Geneva for inspiration.

Click here to access MEA's journal 'Ethics and Wisdom in Medicine'.

Click here to see latest MEA Newsletter is online now.

Last Updated on Tuesday, 08 July 2014 17:23
Written by Dr A Cole   
Wednesday, 12 February 2014 20:39






No Water-No Life: Hydration in the Dying.

Published in 2005 by Fairway Folio. Editor Craig GM. ISBN 0 9545445 3 6


This book highlights the dangers of a regime of sedation without hydration in the dying and documents a decade of debate on this subject that preceded the Liverpool Care Pathway. It will challenge and inform readers in many walks of life. Reprints of key papers give the views of the main protagonists including Ellershaw and Dame Cecily Saunders. Case reports show the complexity of the situation. Some dissenting relatives suffered post-traumatic stress.

Dr Robin Fainsinger a Director of Palliative Care Medicine in Canada who offers his dying patients subcutaneous hydration said “Dr Craig has performed a great service to palliative care for her thoughtful approach in challenging a long held dogmatic practice…Her book is fascinating and informative.”


Sales and distribution.


Volume 1 costs £10 per copy + p &p of £1. 50

For online sales go to www. OR


Usually in stock at St Pauls’ Bookshop by Westminster Cathedral in London

and at Wildy’s Legal Bookshop behind the Royal Court of Justice off the Strand.


Postal sales only from PO Box 341 Enterprise House Northampton NN3 2WZ

e mail: This e-mail address is being protected from spambots. You need JavaScript enabled to view it


NB Stocks are limited. When they are gone there will be no reprint.



Patients in Danger: the Dark Side of Medical Ethics.

Enterprise House (UK) Editor Craig GM. ISBN 0 9552840 0 7 (p 272.) 


This book was published in June 2006. It covers tube feeding as a form of life

support and explores ethical dilemmas created by decisions to withdraw or withhold

tube feeding. Medical ethical problems are illustrated by case reports, press

reports and analysis of professional guidelines. American author Wesley J Smith

paints a worrying picture of futile care theory as practised in the USA, yet we in the

UK are following suit.

Medical practice has become polluted with politics as governments seek to contain the costs of health care. The frail elderly are now at risk. Society is deeply divided about how to tackle these problems. This book is highly topical and should be of interest to all who are involved in difficult “end-of-life decisions”.



Sales and distribution.


Vol. 2 costs £15. 00 + p&p of£1. 50


Online orders or personal shoppers are welcome at St Pauls’ Bookshop by Westminster


Cathedral and Wildy’s Legal Bookshop under Lincoln’s Inn Archway, London WC2.

For online sales go to: www. OR


Postal sales only from PO Box 341 Enterprise House Northampton NN3 2WZ



Last Updated on Tuesday, 08 July 2014 17:03