In June 1999 the BMA published important guidance on the withholding/withdrawal of ‘medical treatment’, so defined as to include food and water delivered by tube. The guidance endorses the withholding/withdrawal of tube-delivered food and water not only from patients in pvs but also from other non-terminally ill patients such as those with severe dementia or serious stroke. The underlying justification for non-treatment appears (as in Bland) to be that such lives are not worth living and that it is right to end them by purposeful omission.

Published by the Medical Ethics Committee of the BMA, the guidance was prepared by a working group comprising nine of the Committee's twenty-five members and was written by three members of the BMA administrative staff. The Foreword states that a consultation exercise which the BMA had carried out in 1998, and which had generated over 2,000 responses, has revealed a need for guidance and that one of the most difficult issues was withholding/withdrawing tube-delivered food and water. Confusion had arisen from the fact that judicial guidance on this question related only to patients in pvs, and the BMA therefore wanted to provide guidance outlining the criteria to be applied in other conditions, such as advanced dementia or severe stroke. The guidance sought to ‘document the type of factors which should be taken into account, the process which should be followed and the safeguards which should be in place to ensure that these decisions, and decisions to withhold or withdraw other life-prolonging treatments, are made appropriately’.