UK Judge Rules Starving Minimally Conscious Patients to Death Does Not Always Need Court Approval

LONDON — A judge in the United Kingdom has ruled that permission from the courts is not necessary when doctors and family members agree that food and water should be withdrawn from a person in a minimally conscious or persistent vegetative state in order to end their life.

The case, decided by Justice Peter Jackson of the Court of Protection, centered on a 50-year-old woman, simply identified as “M,” who suffered from Huntington’s disease, a terminal brain condition that progressed to the point that she became bedridden and lost nearly all signs of awareness.

Her mother opined in court documents that it would be “cruel” to keep her daughter alive in such a state, and asserted that her daughter would feel that “her life is being prolonged for no purpose, where she has no quality of life.” The woman’s husband agreed, remarking that “the PEG feed is keeping her alive, with no possibility of change or cure; it is simply causing M to suffer.”

Doctors reviewed the woman’s case, and noted that the woman grimaced when her position was changed, an indication of discomfort. Her heart rate also went down when given pain medication.

Dr. Edward Wild, a Huntington’s disease care specialist at UCL Institute of Neurology, reviewed a report provided by the woman’s clinician, and agreed that withholding nutrition and hydration (CANH) would be in the woman’s “best interests” because it was “likely” that she would someday die of severe pneumonia.

“It is impossible to be certain whether and how much M is currently suffering on a day-to-day basis because we cannot assess her awareness of her situation,” Wild wrote. “However, she is not comatose, and it is likely that she does retain some general awareness of the situation as well as an ability to experience discomfort.”

But because the situation might be “distressing” to the woman in regard to her “quality of life,” he concluded that “M’s best interests favor withdrawing artificial nutrition and hydration.”

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“I recommend nutrition and hydration be withdrawn together, as sustaining hydration without nutrition may prolong M’s general suffering and any additional suffering from hunger, without any particular benefit,” Wild stated.

Another doctor affirmed the viewpoint.

In analyzing the information, along with pertinent laws, Jackson accepted the stance of the woman’s family and doctors that CANH should be withdrawn and that the woman be placed on palliative care.

The woman consequently died in August following her feeding tube removal and discontinuation of hydration.

But the question remained as to whether such cases involving withholding life-saving nourishment need to be brought before the court for approval in the first place. While Jackson concluded on Wednesday that the “right to life belongs to everyone, enabled and disabled,” he said that if no disagreement exists, a decision between the doctors and family is customarily sufficient.

“In my judgment, therefore, a decision to withdraw CANH, taken in accordance with the prevailing professional guidance—currently the GMC’s Good Medical Practice guidance, the BMA guidance ‘Withholding and Withdrawing Life-prolonging Medical Treatment’ and ‘End of Life Care’ and the Royal College of Physicians’ Guidance on Prolonged Disorders of Consciousness—will be lawful…,” he wrote.

“[T]he decision about what was in M’s best interests is one that could lawfully have been taken by her treating doctors, having fully consulted her family and having acted in accordance with the MCA (Mental Capacity Act) and with recognized medical standards,” Jackson reiterated.

However, he added that “every case is intensely fact-specific, and those considering withdrawal of CANH should not hesitate to approach the Court of Protection in any case in which it seems to them to be right to do so.”

So-called “right to die” groups cheered the decision.

“When all parties—family, the hospital and treating doctors—are agreed on what someone would have wanted for their care, it seems absurd to require a costly court process to confirm this,” said Sarah Wootton, chief executive of Compassion in Dying.

But Dr. Peter Saunders of the Care Not Killing Alliance decried the ruling as presenting serious risk for other patients to be starved to death out of the assertion that dying was in their “best interest.”

“This court decision sets a dangerous precedent and should be appealed,” he said. “Taking these decisions away from the court of protection removes an important layer of legislative scrutiny and accountability and effectively weakens the law.”

“It will now be more likely that severely brain damaged patients will be starved or dehydrated to death in their supposed best interests and that these decisions will be more influenced by those who have ideological or financial vested interests in this course of action,” he lamented.

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  • Trilemma

    If you don’t want family, doctors and judges making decisions like this about your life then make sure you have a living will and that the hospital has a copy.

    • james blue

      And whatever the will says should be honored.

    • Amos Moses – He>i

      i have a signed tattoo on my chest …..

      “DNR —– GET OFF ME!”

      just kidding ….. but that is an option …………

      • mr goody two shoes

        Living wills disappear all the time when your dead or about to be. Perhaps a sign don’t forget I still get thirsty and hungry while alive tattooed on the chest would not be a bad idea.

  • james blue

    Living wills are a wise route and should be honored.

    • Beamer

      It is especially disheartening when there is no living will, and even though they were talking and eating for me, when I left they said she went into a coma almost immediately and within 2 days they did this to her. It took her a week to die. She wasn’t ready to die, she just wanted her family to leave her alone. But they had the authority and they wanted her money, so they had her killed this way. I have not spoken to the family member who said OK to this since I told her she murdered her mother. They did not appreciate that she came out of her supposed delirium when we went to visit her and she talked and laughed and she ate for the first time in days when I was there without a problem. Ate it all too, even though they told us she had not eaten.
      I don’t agree with this as I think it is cruel and unusual punishment and it certainly should depend on a person being brain dead.

      • james blue

        I can’t imagine a person who can talk and eat would be medically pronounced to be in a vegetative state.

        • Beamer

          It’s true. I was so upset as I loved her so much. All her kids wanted were her money and the one that had the authority ripped every single sibling off from part of the money they were left.
          I have no idea why the doctor allowed it. I know the nurses knew because it was one of them that brought in her lunch that I fed her, and she saw her behaving normally with us and knew that she ate every last drop for me.
          If I had known that they would be doing that, I would have stayed and slept in her room on the floor to keep her going. Sometimes I feel guilty for it, but I remind myself that she obviously wanted to see us before she died and perked up way beyond what she was before our visit so we could spend the time together. I have to be thankful for the chance to see her and to let her enjoy the visit, rather than guilty for not staying.

          I can’t imagine a doctor not wanting to put it off a while since she was awake and alert and eating 2 days before. I would not put it past them to bribe him or lie about her behaviour with me. They were pretty pissed off at me because their mother said (in front of one of them) that she would miss me and that she loved me. She didn’t say things like that to them because of the way they treated her. I cried throughout her funeral and didn’t see one tear from any of them. I still miss her very much.
          Thanks for the reply!

    • mr goody two shoes

      That’s why they disappear when siblings fight over stuff.

  • mr goody two shoes

    No ones ever done what I or you wanted before why do you expect them to when your about dead ? I would rather not die of thirst hunger might be unpleasant to. By the way I kinda enjoy breathing to.

  • 0pus

    Abortion is always the slippery slope to euthanasia.

    Once you lose respect for life, all sorts of horrible things happen.

  • mr goody two shoes

    Don’t hate your children bring them up in a christian home as they eventually choose your doctors and who takes care of many of you.