The British Government has approved 'living wills' despite fears by critics that the move will let in euthanasia by the back door. A report from the Lord Chancellor 'respects the right' of people to draw up legal instructions for doctors, allowing treatment to be stopped if they become chronically sick or injured, even if it leads to their death.

It also opened the way for a new law of 'continuing power of attorney', which would allow a dying person to nominate someone to hold the power of life and death over them when they could no longer take decisions for themselves.

Lord Irvine's report insisted that living wills do not amount to euthanasia, adding, "The Government wishes to make absolutely clear its complete opposition to euthanasia, which is and will remain illegal". He promised safeguards to prevent abuse of the new power of attorney. His plans follow years of controversy over the issue and took two years to be compiled in the face of entrenched opposition to his ideas. Launching his report, A Charter for Carers, he said: "The present law offers little protection to someone who is unable to make decisions or to the carer whose actions would have little or no legal basis"

"The Government has set out to provide an understandable framework in which the interests of the mentally incapacitated are protected and in which carers can act with confidence"

The medical decision at the heart of living wills is whether to withdraw nourishment and water from patients in a persistent vegetative state or who are otherwise fully incapacitated. Courts have ruled that in such circumstance food and fluid count as medical treatment. Lord Irvine's report ruled out a new law on living wills because of the 'division of opinion' on the issue.

However, it added that there were enough legal precedents to allow the courts to enforce living wills, including the case of Tony Bland, who was allowed to die after being left in a coma by the 1989 Hillsborough soccer disaster.

The Government also endorsed the British Medical Association's guidelines on the issue. These warn that doctors may be 'legally liable' if they disregard the advance instructions of a patient that they should be allowed to die if permanently incapacitated. There will, however, be new laws to cover the rest of the complex legal field of incapacity.

These will include a new definition of incapacity and what can be said to be in the best interests of the patient. The legislation is likely to support the idea put forward in the courts that the best interests of some patients can lie in death. Carers will get a new 'general authority to act reasonably' allowing them the right to pay bills and administer drugs from day to day.

Safeguards on those given the continuing power of attorney include rules insisting that all relatives of the person concerned should be informed and that the choice should be made while the patient was still able to make decisions. The nominee would usually be a relative but could also be a trusted doctor or lawyer

This article was printed in  the UK newspaper, The Daily Mail, on the 28th October 1999