Doctors can withdraw feeding from patient in minimally conscious state, judge rules

BMJ 2015; 351 doi: http://dx.doi.org/10.1136/bmj.h6292 (Published 20 November 2015)

A judge has ruled for the first time in a UK court that a patient in a minimally conscious state should have artificial feeding withdrawn and be allowed to die.

Mr Justice Hayden concluded at the Court of Protection in London that it would be “disrespectful” to the 68 year old woman, “N,” in the end stages of multiple sclerosis “to preserve her further in a manner I think she would regard as grotesque.”

In 1993, in the case of the Hillsborough football ground disaster survivor Tony Bland, the House of Lords, then the highest court in the United Kingdom, ruled that doctors need not keep someone alive if life was conferring no benefit. In a series of cases since then courts have authorised the withdrawal of artificial nutrition and hydration from patients in a persistent vegetative state.

In 2011 the Court of Protection considered for the first time the case of a patient in a minimally conscious state, a level just above persistent vegetative state. But after hearing evidence from the patient’s family about what her wishes would have been, Mr Justice Baker ruled that she had “some positive experiences” and that the presumption favouring the preservation of life should prevail.1

In the latest case, evidence from N’s daughter, son, and former husband about the sort of woman she was and what she would have wanted persuaded the official solicitor, who represented her and initially opposed the family’s application to discontinue feeding, to change his mind.

N, who lives in a care home in northwest England, was given a diagnosis of multiple sclerosis 23 years ago. Her condition is unchanged since 2008 and she would be deemed to be in persistent vegetative state but for her ability to fix and track objects in her line of vision.

After hearing the family’s evidence the judge said that he was “left with little doubt that Mrs N would have been appalled to contemplate the early pain, increasing dependency, and remorseless degeneration that has now characterised her life for so long” and would have wished to discontinue treatment “some considerable time ago.”

He added, “Ultimately, I have concluded that her wishes, so thoughtfully presented by her family, coupled with the intrusive nature of the treatment and its minimal potential to achieve any medical objective, rebut any presumption of continuing to promote life.”

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