Catholic Medical Quarterly Volume 69(3) August 2019


From: Fr Hugh Mackenzie

Many thanks for the helpful article on the significant weaknesses of the Mental Capacity Act (MCA, “Would you refuse a dying man water?" (May, p.13). It was perhaps written before the 2018 BMA Guidance on Clinically Assisted Nutrition and Hydration and Adults who lack consent. While this does not allay the articles’ key worries, its definition of “best interests” may allay one or two fears. For instance Best interests is defined as having a “strong presumption” in favour life prolonging treatment. This presumably would apply in the cases of uncertain diagnosis and prognosis you describe in section 3. And Appendix 1 uses case law to show that the will of the patient is only “almost invariably” the determining criteria for best interests (calming your conclusions in sections 2 and 6 a bit). However this also seems to permit doctors to make “better off dead” judgments even out of tune with the patient’s desires..

Moreover, you have well pointed out that the tenor of the MCA strongly encourages the idea that treatments and care, which are morally and medically crucial, are just options.

What I understand to be the key point of the piece still clearly remains. The MCA has removed objective criteria concerning the duty to keep alive where practicable and to “do no harm”. It is indeed worrying and I hope the piece’s call to send in examples of worrying application of the MCA.