The UK Supreme Court has declared that both doctors and families are not required to apply for court approval in order to end the medical care of patients who are in a permanent vegetative state.
Previously, medical practitioners were legally obliged to seek the permission of the Court of Protection if they wished to discontinue the treatment of a patient who was in a ‘‘prolonged disorder of consciousness.’’ This ruling has withdrawn this requirement, allowing the patient’s doctor and family to come an agreement between themselves, based on the patient’s best interests.
The decision was made in relation to the case of Mr Y, a man in his 50s who suffered a cardiac arrest, causing severe brain damage and leaving him in a vegetative condition. He needed to be administered with clinically assisted nutrition and hydration in order to survive and was admitted to an NHS rehabilitation centre for assessment.
Following the conclusion of examination, the centre’s physician declared that he was in an unconscious, vegetative state with little prospect of improvement. Mr Y’s family and the medical staff involved in treating him agreed that it would be in his best interests if his assisted nutrition and hydration was stopped, which would allow him to eventually pass away over a period of two to three weeks.
The family and the NHS submitted an application to the High Court for a declaration stating that court approval for the ending of medical treatment of a patient in a permanent vegetative state was not compulsory, as such a procedure could often take many months and cost both the families and the health services thousands of pounds in legal fees.
The High Court concurred that such permission should not be necessary where both doctor and family are in agreement, and permitted an appeal to the Supreme Court. The Official Solicitor, acting on behalf of Mr Y, contested this and stated that every case wherein a person is in such a state, court approval must be sought to withdraw care in order to provide for the proper safeguarding of the patient’s position.
Mr Y’s family and the NHS opposed this stance, asserting that mandatory approval from the courts was not laid down in common law or in the European Convention on Human Rights (ECHR), therefore there was no universal requirement imposed upon either families or medical staff to seek court permission prior to the discontinuation of treatment.
The Supreme Court ruled in favour of Mr Y’s family and the NHS, concluding that court approval in such circumstances is not established in either common law or the ECHR. It was stated that if all legislative provisions are adhered to and there is agreement between medical staff and the family as to what is in the best interests of the patient, then no application needs to be made to the court. However, emphasis was put on the fact that this may not always be the case, and some circumstances may require court assistance.
Click here for the full Supreme Court judgement.