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Concern voiced at court ruling  

03 August 2018

ISTOCK

FAITH and disability groups have expressed concern at a UK Supreme Court ruling this week that allows doctors and family members, without going to court, to withdraw treatment from patients in a vegetative or minimally conscious state.

Under the ruling, published on Monday, medical staff will be allowed to withdraw food and liquids, allowing patients to die, without having to apply to the Court of Protection.

The Supreme Court Justice Lady Black said in her ruling that, while “no life is to be relinquished easily . . . there may come a time when life has to be relinquished because that is in the best interests of the patient”.

Dr Peter Saunders, the director of Care Not Killing, an alliance of disability groups and faith organisations which includes the Church of England, said that the ruling “removed an important safeguard from those without a voice. . . It will make it more likely that severely brain-damaged patients will be starved or dehydrated to death in their supposed best interests.”

He said that Lady Black’s ruling had “dramatically moved the goalposts on end-of-life decision-making”.

He went on: “Once we accept that death by dehydration is in some brain-damaged people’s ‘best interests’, we are on a very slippery slope indeed. There is the real risk that those who have vested ideological, financial, or emotional interests in a person’s death could exert undue influence.

“Recent experiences around the Liverpool Care Pathway, and in Gosport hospital should make us wary of leaving doctors without proper regulatory and legal oversight.

“When difficult medical decisions are left to doctors who are inexperienced, inadequately trained, or working under intense pressure, bad decisions can be made. When they are left to those who believe that brain-damaged patients are better off dead, then we are in a very dangerous place indeed.”

The case was brought to the Supreme Court after a banker in his fifties suffered a heart attack that resulted in severe brain damage. Although the man has since died, the case was allowed to progress to enable a court ruling to be made.

Care Not Killing said that the ruling could have implications for thousands of patients currently in NHS care in the UK, in either a permanent vegetative state (PVS) or minimally conscious state (MCS). Most are being kept alive, it is believed, through medical intervention in nursing homes.

The decision was welcomed by others, however, including families of patients. Natalie Koussa, a director of the charity Compassion in Dying — a sister organisation to the assisted-dying campaign-group Dignity in Dying — said: “[This] brings much needed clarity to doctors and loved ones of those who have sadly been left in a vegetative or minimally conscious state, following severe illness or injury.

“The court’s decision also recognises the fact that sometimes, sadly, it is in someone’s best interests to withdraw treatment. It will allow those closest to a person — their loved ones and medical team — to feel supported and empowered to make the right decision for the person, even when it is a difficult one.”

The right to withdraw treatment from vegetative patients began in 1993, when the House of Lords agreed that removing “clinically assisted nutrition and hydration” — where a patient is fed through tubes — from the Hillsborough victim Tony Bland, who had been in a vegetative state since 1989, did not constitute murder.

They said, however, that referring similar cases to the Court of Protection was best practice.

Lady Black said that agreement between families and doctors was a sufficient safeguard, although she urged families to continue to apply to court where there were differences of opinion with medical professionals.

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