The Supreme Court has today (Monday 30 July 2018) confirmed that judicial approval is not needed when withdrawing life-prolonging treatments from individuals with a prolonged disorder of consciousness (such as minimally-conscious or persistent vegetative state).
Judging on the Mr Y case, which involves a man in a vegetative state following severe brain injury caused by a cardiac arrest, the Supreme Court has upheld a previous High Court decision that clinically assisted nutrition and hydration (CANH), a life-prolonging treatment, can be withdrawn from a person in a prolonged disorder of consciousness without having to go to seek permission at court, if the family and medical team agree that would be in the best interests of the person.
This means that the families and medical teams of other individuals like Mr Y who are in a prolonged disorder of consciousness will not have to apply to the courts to approve withdrawal of CANH, provided they agree about the best treatment decisions for the individual, and where there are no other doubts or concerns.
Responding to the judgment, Natalie Koussa, Director of Partnerships & Services at Compassion in Dying, said,
“We welcome the Supreme Court’s decision today, which 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. Today’s judgment is an important move towards more person-centred care, because it means that what’s best for the individual can be decided by their medical team and loved ones, and acted upon more quickly, rather than spending months or even years waiting for a court decision.
“The court’s decision today 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.
“Mr Y’s case, like the cases of Mrs M and Paul Briggs before him, is a tragic example of what can happen when people do not record their wishes for future medical treatment and care. If Mr Y had recorded his wishes around refusal of treatment beforehand in a legally-binding way, doctors would have been duty bound to follow his wishes without the need for a court case.
“Whilst this judgment means that others in the same situation can now avoid court, cases will still go to court where a person in persistent vegetative or minimally conscious state had not set out their wishes for medical treatment and there is a dispute within or between family and medical team about whether CANH is in the best interests of the individual.
“No one plans to have an accident or become unwell – but there are things you can do now to help ensure that your wishes can be known about and followed in case tragedy does strike. An Advance Decision, also known as a Living Will, is a legally-binding document that allows you to state whether you would want to refuse life-prolonging treatment should you later become unable to make or communicate these decisions for yourself. Rather than leaving these choices up to family members, doctors, or the courts, who may disagree over what you would have wanted, making an Advance Decision means that you can remain in control of future decisions about your care and treatment and feel reassured that your wishes will be followed. You can also make a Lasting Power of Attorney (LPA) for Health and Welfare, to give a trusted person(s) the right to make such decisions on your behalf.
“Free, specialist information on how to plan ahead and record your wishes is available to all via Compassion in Dying’s Information Line (0800 999 2434) and website.”
For further information or interview requests, please contact Ellie Ball, Media & Campaigns Officer, at firstname.lastname@example.org or 0207 479 7732
Notes to Editor:
The Supreme Court’s decision:
The Supreme Court’s decision is available here: https://www.supremecourt.uk/cases/docs/uksc-2017-0202-judgment.pdf
The press summary prepared by the court is available here: https://www.supremecourt.uk/cases/docs/uksc-2017-0202-press-summary.pdf
The term “prolonged disorder of consciousness” encompasses both a permanent vegetative state (sometimes referred to as a persistent vegetative state, and often shortened to “PVS”) and a minimally conscious state (or “MCS”).
“Prolonged disorder of consciousness” is commonly shortened to “PDOC” and that practice is followed in this judgment.
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