LANCASTER, August 3, 2004 ( – Leslie Burke of Lancaster, UK has won a legal challenge to the General Medical Council (GMC) guidance on the treatment of the terminally ill. Mr. Burke, whose cerebellar ataxia may eventually prevent him from communicating his views on his own treatment to family and doctors, is overjoyed: the High Court ruling may save his life from being prematurely cut off.  In the course of his appeal, Mr Burke argued that the GMC guidance should be changed to oblige doctors to assume that the patient would want to keep on living were he in a condition to make his desires known. This way, doctors will not have to act on a patient’s supposed wishes or make value judgments on a person’s quality of life. Justice Munby took issue with the GMC guidance, saying that “one can see error creeping into the guidance in different ways”. A source of concern is its tendency to focus on the patient’s right to refuse treatment rather than on the right to receive it. In practice, nutrition and water are sometimes withdrawn from patients who are unable to voice their desires simply because their condition is severe, even though death may not be imminent. The assumption behind this practice is that one’s right to life depends on one’s quality of life.  In Canada, the Euthanasia Prevention Coalition won an important court case last January when they intervened on behalf of Joyce Holland. The 81-year-old Alzheimer’s sufferer had previously stated to her attorney that she wanted medical treatment, and yet her physician petitioned the court to remove all medical treatment and allow her to die. The court ruled in her favor.  Both court cases may be important steps in a much-needed clarification of principles. Dr Michael Wilks, chair of the British Medical Association’s medical ethics committee, remarked: “A decision to withhold or withdraw treatment from a patient who is dying or seriously ill is one of the most difficult and complex decisions a doctor can make.” Be that as it may, the ethical principles are simple in fact and ought to be so in law.  See the BBC coverage:   jo