e-mail gill@willtolive.co.uk

Do Doctors always know best?

With the medical ethics pendulum swinging from keeping people alive at all costs to letting people die when their prospects for life are not perceived to be tenable, there is a danger that some disabled people's lives will be seen by doctors as less tenable than everyone else's.

Disabled people are still regarded as second class citizens even though things are improving slowly. But there are still two ways of looking at disability, the Medical Model and the Social Model of disability.

The medical model of disability focuses on what the person has wrong with him/her, what he/she can't do and how their body or mind differs from the norm. Looked at like that a disability is a negative thing, something that can't be cured and it is easy to assume that the person is likely to be a burden to society all their lives.

The social model of disability starts from the premise that disabled people are exactly the same as everyone else and they are disabled by the lack of access and equality that society affords them. If a wheelchair user can't get into a shop because there are steps, it is the steps that have disabled him or her, not the fact that he/she can't walk because of............. If the steps are removed then he/she can get into the shop and is not disabled.

Doctors are necessarily applying the medical model all their working lives because it is part of their job. By and large their training does not equip them to look at disability in any other way. So when a doctor is faced with a decision that is based on how good the quality of life of a disabled person is, they are likely to judge it to be poor, whether that is really the case or not.

The B.M.A.'s guidelines on withholding treatment and sustenance leaves the decision to stop treating, feeding and/or hydrating a patient solely on the doctor's judgement of their past, present or future quality of life.

Many severely disabled people can and do contribute fully to society but if they turned up at hospital critically ill, without anyone to support them, many doctors would find it easy to foreshorten their lives, without knowing they were making too hasty a judgement.

Doctors therefore need a great deal more training and the guidelines need changing to reinforce everyone's right to life.