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Life support woman allowed to die


The High Court has given a health trust permission to lawfully withdraw life-sustaining treatment from a woman in a permanent vegetative state.

Mr Justice Charles, sitting at the Court of Protection in London, ruled that stopping artificial nutrition and hydration would be in the best interests of the 54-year-old mother of four.

Members of her family, who the court heard were “entirely supportive” of the application made by the trust responsible for her care, were present in court for the decision.

Following a “collapse” in 2009, the woman, who cannot be identified for legal reasons, suffered “extensive hypoxic brain damage”.

The judge said the application by a NHS trust, which also cannot be named, was for a declaration “to render lawful” the withdrawal of hydration, nutrition and medication for a heart condition.

He said: “The consequence of that is that very sadly the patient will die.”

The judge said he was “satisfied that appropriate testing and observations have been carried out by the appropriate qualified professionals” over a significant period of time.

There was “convincing evidence from those who are nearest and dearest to her that there is nothing in her approach to life which would indicate that, if she were able to say something about it, she would not completely support what the family are asking me to do”.

He concluded: “In my judgement this patient has permanent extensive brain damage and is in a permanent vegetative state. Further treatment would be futile.”

The declaration sought was “in her best interests”.


Readers' comments (15)

  • michael stone

    The judge's ruling is what the MCA says, if there is no prospect of clinical improvement - if the patient has not clearly expressed wishes, it is those who are likely to understand her wishes (her family, etc) who 'comment on what she would say, if she could'.
    I am pleased, he was consistent with the MCA !

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  • since when has turning off life support become the decision of a judge? is this no longer a clinical and family decision?

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  • michael stone

    There was a report in The Telegraph on the 26th (p2) during the hearing of this case, and it seems the woman had suddenly deteriorated clinically, so she presumably had not expressed her own views on the issues (as someone might in ‘contemplation of illness or death’). A lawyer claimed that the woman was ‘otherwise clinically stable’ and ‘has signs of awareness’.

    All of her family, as I understand it, said that if she were mentally capable, and considering her clinical condition, the woman would have preferred to be dead.

    A nurse apparently said she feared that relatives do not ‘fully understand’ how ‘unpleasant an experience withdrawing treatment might be for them’ – which could well be true, but appears to be legally irrelevant.

    The principle and intention of the Mental Capacity Act, which clearly applies here, is to try and extend a patient’s right to refuse an offered treatment, into a period of mental incapacity. The primary principle, is ‘can I be reasonably sure, of how this patient would answer, if somehow I could ask him ?’. In this case, when the woman had not specifically discussed this situation, then the only way one can attempt to discover that, is to describe the clinical situation and prognoses to the people ‘with deep life experience of her’ (relatives, etc – but almost invariably not the clinicians who are involved) and ask them ‘Do you think she would refuse the treatment ?’. A question they must all consider individually, but with the exchange of any relevant information. It becomes problematic if different answers emerge (not dealt with by the Act) but in this case, everyone who could answer that, apparently said ‘she would prefer to die’ – in which case, logically, you must then behave as if the patient had herself given that answer.

    The comment from the nurse, about how hard the death might be on the relatives, is not relevant to the judge’s decision (unless, it was concluded that the patient would have been influenced by that as a factor) because he is supposed to be trying to decide what she would have said, if she could have answered herself. If he had not judged as he did, then it would have driven a coach and horses through the ‘logical consistency’ of the Mental Capacity Act !

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  • michael stone

    Anonymous | 28-Jul-2011 3:40 pm

    Judges do not want to get involved, but clinical guidance and understanding is often confused. So people end up asking for court rulings.
    If the patient has not clearly expressed wishes, then the MCA calls for this process:

    2a) the clinicians work out the prognoses for an incapable patient,
    2b) the prognoses are described to everyone who has sufficient ‘life experience of the patient to ‘justifiably suggest’ what the patient would have said, if the patient could answer in person’,
    2c) if all of the people in 2b, which is the group of {almost always} non-clinicians who ‘possibly understand the patient’s likely wishes’, give the same answer then you behave as if that answer was given directly by the patient.

    But 'the system' has problems with 2c, because it is very clear that 2c does not say 'doctors make the decisions'. Unfortunately, the logical interpretation of the MCA, leads to complex allowable behaviour and not to a simple set of doctor-led 'rules' as the system would prefer.

    I hope this judge, explains section 4(6) properly - then, some progress might be possible !

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  • Michael Stone

    looks like you are blocking yet another constructive debate among professional colleagues. It is getting very tiresome, bordering on the ridiculous, and a total waste of time trying to comment on this site.

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  • Anonymous | 28-Jul-2011 3:40 pm".......since when has turning off life support become the decision of a judge? "

    A-Since Airedale NHS Trust v Bland 1993. The first test case for this type of decision. The difference between withdrawing treatment on one patient being kept 'alive' by drugs and ventilatiion and another by nutrition and hydration was a key factor in this Human Rights case.

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  • i have always perceived this as a clinical team decision made with the family and one in which I have sometimes had to participate. but I guess with increasing complexity this has changed just like the necessity to call upon a judge of the supreme court of the UK to decide whether elderly patients should wear pampers at night instead of receiving care! the medical and nursing professions don't count for much any more but at least they can discharge their responsibilities and in that way do not risk litigation if there is a change of attitude.

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  • Anonymous | 28-Jul-2011 3:40 pm

    since when has turning off life support become the decision of a judge? is this no longer a clinical and family decision?

    If you read the article carefully it does not mention the fact that the judge is ordering that they turn off the life support machine, what he is doing is asking the staff to withhold hydration and nutritional support, something totally different to clinical decision and which would require judicial prescidence. This is basically because you are withdrawing basic human needs and once a doctor starts a patient on nutritional support they have a very hard time trying to withdraw it ethically unless they can prove it is causing damage. The hypocratic oath is sometimes a hinderance in these cases

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  • Anonymous | 29-Jul-2011 11:24 am

    in fact there is no mention of a life support machine in the article but presumably if this was the issue it would appear that this must now also be a court decision as it also involves ending life?

    it looks to me in this case above that the doctors, nurses, and relatives would first make this clinical decision and then have to appeal to a judge to approve their decision. If this is the case it is alien to me as previously it was a decision made by a clinical team and the patient's family in the patient's best interests and we always had to evaluate whether it really was in the interests of the patient or that of the family. in this, however, I only experienced one case where it was strongly suspected that the family might have been putting their own interests first but hard to prove and perhaps recourse to legal support in this instance would have been helpful for the doctors who give the final orders.

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  • michael stone

    I have just realised that the case reported above, appears to be similar but not the case I had seen reported as woman M - so the COP has recently had 2 similar and concurrent cases. The theory/law stands, however - it all goes to 'what the patient would have said, if the patient could speak'.

    I wish people would read the Mental Capacity Act itself, and then think about it ! But in essence, the problem is that people become very nervous 'around preventable deaths' !

    Anonymous | 29-Jul-2011 10:11 am

    I have been debating the current clinical interpretation of the MCA, with the people who write high-level guidance, for 2 years ! I probably understand the MCA, far better than you do !

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