Right to die case rejected by judge
A brain damaged woman should not be allowed to die, a high court judge rules. The case raises key questions on what it means to live and die in the modern world, an ethics expert tells Channel 4 News.
The 52-year-old woman is in a minimally conscious state after suffering profound brain damage in 2003. Her family wanted life support withdrawn, saying their relative would not have wanted “a life dependent on others”.
The case is thought to be the first time a judge has ruled on whether life support should be withdrawn from a person who is minimally conscious rather than in a persistent vegetative state.
Relatives said the woman would not want to live “a life dependent on others”, but a high court lawyer argued that the woman is “otherwise clinically stable” and nutrition should not be stopped on this basis.
The local health authority also opposed the relatives’ case, saying the woman’s life was “not without positive elements”.
They believe that M was clear that she would not have wanted to live in the condition that she is in. Yogi Amin, family’s lawyer
The case has stirred emotions on both sides of the debate – those who believe everyone has a right to life, and those who believe that there is an equally legitimate right to death.
Deputy Director of the Centre for Ethics in Medicine at the University of Bristol, Dr Richard Huxtable, told Channel 4 News that the different views on the value of life all said something “very important about what it means to live and die in the modern world”, and stressed that hearing all of these voices and views was critical in these controversial and difficult cases.
He added: “It looks like today what has been emphasised is that, in uncertain cases, err on the side of life.”
Heart-breaking years
The court heard that the woman, who cannot be identified for legal reasons and was referred to as M in court, suffered profound brain damage after contracting viral encephalitis in 2003.
She was in a coma for several weeks and originally thought to be in a persistent vegetative state. Doctors later decided she was actually in a minimally conscious state, just above a persistent vegetative state.
The judge, Mr Justice Baker, said M had “some positive experiences” and there was a “reasonable prospect” that those experiences could be extended.
Value of life
Medical ethics expert Dr Richard Huxtable told Channel 4 News decision makers in cases like this have two key questions: on what basis is the decision over withdrawing life support made, and who makes that decision?
Who?
There is a strong emphasis on patients, where possible, deciding for themselves. If not, families – with help from support organisations – are central in terms of what they would have wanted, alongside clinical expertise and medical guidelines. If there is a disagreement, this can go to court, but there are also other methods such as clinical ethical committees made up of people including patient representatives, healthcare experts and chaplains, who can advise.
How?
Judges take into account three accounts of the value of life:
Intrinsic value – the idea that life itself is valuable, and should be prolonged
Instrumental value – if a vehicle is broken, you may want to get rid of it
Self-determined value – turning all of these questions to what the patient feels, whether any prior wishes have been expressed like an “advanced decision” or living will, or whether someone has a proxy to speak for them.
Yogi Amin, a partner with law firm Irwin Mitchell, speaking on behalf of M’s family, said: “There can be no question that the past eight years have been extremely heart-breaking for them all.
“They love her dearly and want only what is best for her, and it has been desperately difficult for them to make this application to court for treatment to be withdrawn.
“They believe that M was clear that she would not have wanted to live in the condition that she is in.
“However, the judge has decided in this particular case, after considering all the evidence, that balancing the benefits and disbenefits to M, does not fall on the side of withdrawing treatment.
“This is a very important judgment. The law has been clarified and, going forward, in all such cases of patients who are in a minimally conscious state, the High Court does now have the power to decide on whether it is in that patient’s best interests for treatment to continue, or whether the patient should be allowed to die naturally, with dignity.”
Campaign groups said the case showed how important it was for people to make decisions about their own care while they were still able to do so.
Dignity in Dying and Compassion in Dying focus on choice for patients at the end of their lives, rather than cases like this, but stressed that those who feared this situation had the power to ensure that they would never face it.
Sarah Wootton, Chief Executive of Compassion in Dying, told Channel 4 News: “This incredibly sad and unusual case relates to a patient who is no longer competent to make decisions about her own care.
“People who are concerned about finding themselves in a similar situation can set out their wishes in advance, in case of a loss of capacity by making an advance decision, or they can appoint a lasting power of attorney to make decisions on their behalf.”
