weekly update, 30 March to 4 April

weekly update, 30 March to 4 April The Mental Capacity Act 2005 comes partially into effect in England and Wales this month, and the Daily Mail reports on serious concern from several doctors opposed to elements in the Act which would give legally binding force to living wills and healthcare powers of attorney. Dr Peter Saunders of the Christian Medical Fellowship said that the act was dangerous to mentally incapacitated people who are not dying. Dr Philip Howard expressed his unwillingness to allow a patient to die of unrelieved thirst, and Dr Adrian Treloar said that if asked to kill patients on the authority of the Act he would refuse. [Daily Mail, 30 March ] The Glasgow-based Herald reports that The British Medical Association (BMA) has published guidelines for end-of-life treatment. The aim of the guidelines is to make doctors and patients more aware of their legal rights and obligations. No mention is made in the report of the Mental Capacity Act, which does not apply in Scotland. Dr Lewis Morrison, the Scottish representative on the BMA ethics committee, is quoted saying: "The worst situation is one where doctors are too afraid to stop treating because of the fear of being prosecuted." [Herald, 31 March ] The BMA also advises people to consider granting power of attorney over health decisions to a friend or relative, under the terms of the Mental Capacity Act. Attorney's will be able to "choose between treatments" offered by a doctor and: "Any decision must be in the patient's best interests and doctors or family can take the case to a new court of protection" [Guardian, 31 March ] Comment: Section 50(1) of the Act makes clear that that neither relatives nor doctors will have an automatic right to go to the Court of Protection. Independent mental capacity advocates (Imcas) are beginning work this month under the Mental Capacity Act. English and Welsh Local authorities and NHS trusts will be required to appoint an Imca whose purpose will be to help people without friends and family make decisions about serious medical treatment and changes in residence. The advocates will be commissioned by councils and primary care trusts. [Community Care, 2 April ] Formal authority for appointment of Imcas rests with the Secretary of State (in England) and the National Assembly (in Wales). The Human Fertilisation and Embryology Authority (HFEA) in Britain may consider reducing the number of embryos implanted in women undergoing IVF in an attempt to cut the high level of multiple births. They are also expected to outline possible restrictions on what kinds of IVF treatment should be available to infertile couples. Dr Simon Fishel, director of the Care fertility group in Nottingham, said: "The multiple birth issue is a problem. Any responsible practitioner would want to reduce any multiple pregnancy down to a single pregnancy because there are risks." He said that the HFEA should consider encouraging the implantation of single embryos wherever appropriate. [Guardian, 2 April ] The HFEA has denied making any decision on restricting IVF treatment and has said that a public consultation will be launched to decide what action should be taken. [BBC, 1 April ] All women in England are to be given the choice to give birth at home, in a hospital or in a midwife-led unit, according to the government. The promises were first outlined in Labour's 2005 manifesto. The Royal College of Midwives (RCM) has estimated that another 3,000 midwives are needed over the next five years to fulfil the promise. Dame Karlene Davis from the RCM said: "We are obviously concerned that there will need to be enough midwives to make it happen." [BBC, 3 April ] Some experts have warned that women are not sufficiently informed of the risks of giving birth at home. James Drife, professor of obstetrics and gynaecology at Leeds General Infirmary, said that home births were twice as likely to result in foetal death as hospital births, even for women considered to be at low risk. He said: "I don't think the government is being realistic about what can be achieved or entirely honest about the risks." [Telegraph, 3 April ] An American cardinal has urged Catholics to oppose a bill that seeks to legalise assisted suicide in California. Cardinal Roger Mahoney described the bill, which has been approved by the Assembly committee and will now be considered by the Legislature, as "an attack on life." He said: "Assisted suicide is totally unnecessary -- not only is it against God's law, God's plan; we simply don't need something like that." He criticised the Democrat Assembly Speaker Fabian Nunez, who is a Catholic, saying that he "has not understood and grasped the culture of life but has allowed himself to get swept into this other direction, the culture of death." [CNA on EWTN, 3 April ] Pro-life advocates in California have called for Nunez to be excommunicated. Alex Schadenberg, executive director of the London, Ontario, based Euthanasia Prevention Coalition, said: "If Nunez persists in his support for the bill, Mahoney should excommunicate Nunez...To support a bill that allows the intentional taking of human life is a grave act that cannot be condoned and must be treated with the strongest response by all people of goodwill who wish to build a society based on the common good." [Life Site, 3 April ]