Judge says the preservation of life is key

 
Royal Courts of Justice The case was heard at the Court of Protection

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On the face of it, the decision by a High Court judge in the case of M is no surprise - few would have expected a ruling to allow a patient with any level of consciousness and feeling to die.

But a closer inspection of the 76-page judgement shows that Mr Justice Baker did not find his decision a straightforward one.

Preservation of life

The woman, known only as M, suffered profound brain damage eight years ago after contracting a virus. Doctors have concluded that she is "minimally conscious", meaning that she has some limited awareness.

Her family argued that she is in pain, got no pleasure from life, and would not wish to be dependent on others

As has been reported, a key reason for the refusal to allow M to die was because "the preservation of life is a fundamental principle."

Best interests

But Mr Justice Baker accepted that this principle is not absolute. It may seem contradictory, but he also ruled that if M was to have a heart attack, then the current "Do Not Resuscitate" order should be continued.

How can that be? The key here, as in any case regarding a person who is incapacitated or unable to make a decision for themselves, is what is deemed to be in their best interests.

The judge took the advice of doctors that M would suffer further brain damage if her heart stopped which would leave her in a worse condition, and therefore resuscitation would not be of benefit.

Mr Justice Baker went further, leaving it to clinicians, in consultation with the family, to decide whether M should receive antibiotics or other treatment, should it be needed at some future date. He said it would depend on the circumstances.

The judge adopted what's known as a balance sheet approach when setting out the pros and cons of his decision about whether to authorise the withdrawal of M's feeding tubes.

"Die with dignity"

Among the arguments in favour included that she would "be freed from the pain and discomfort from which she is currently suffering, and the prospect of increased pain from her chronic conditions."

He also said that by allowing M to "die with dignity" the court would be acting in accordance with what family members firmly believe M would have wanted.

There were yet more arguments listed in favour. It would mean M would be "spared" further years of life in a minimally conscious state "from which there is no likelihood that she will emerge".

Finally, although M would "experience discomfort and possibly pain and distress" when feeding tubes were withdrawn, those experiences would be "limited in time and can be ameliorated by medication and experienced end of life care".

But, Mr Justice Baker found the arguments in favour of preserving M's life more persuasive.

"Sensate being"

He said "there is a significant risk that the process of dying by starvation and dehydration will cause her pain and distress".

M would continue to experience life as a "sensate being with a degree of awareness of herself and her environment."

He said M would continue to gain pleasure from listening to conversation and music, and "if her room is made more comfortable and homely, her immediate surroundings will become more congenial and add to her pleasure in life."

The judge pointed to medical evidence which suggests that because M is clinically stable, she will continue to experience life at this level for a number of years.

Those on both sides of this argument can draw comfort from the judgement.

The solicitor representing the family, Yogi Amin said it meant High Court judges could now rule in other cases of minimally conscious patients as to whether it was in their best interests for treatment to continue.

Until the case of M, judges had considered the withdrawal of feeding tubes only in cases of patients who were in a vegetative state, where they had no awareness.

Care Not Killing, an alliance of groups which promotes palliative care and opposes euthanasia and assisted suicide welcomed the judgement.

Peter Saunders, its campaign director, said it was "a wise and sensible decision which upholds the law and maintains present levels of legal protection for severely brain-damaged people."

Anguish

This was undoubtedly a complex case with powerful arguments on both sides. The judge acknowledged that his ruling would be a severe disappointment to M's devoted family who had already suffered years of anguish.

There will undoubtedly be extensive debate on this topic. Before anyone rushes either to applaud or condemn the ruling, I would recommend they read the full judgement which Mr Justice Baker very helpfully has made available online.

In such cases there is never a perfect remedy - which could only be for M to recover. Given that impossibility, it is for judges, rather than doctors, relatives or anyone else, to decide between life and death.

 
Fergus Walsh, Medical correspondent Article written by Fergus Walsh Fergus Walsh Medical correspondent

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  • rate this
    0

    Comment number 14.

    The judge has ruled that M should not be allowed to die by withdrawing food and fluids, but CPR would not be attempted and that treatment with antibiotics/medication could be decided upon by clinicians and family. Any sign of an infection and the family and clinicians could decide not to implement treatment - M would die - possibly quicker with septicaemia than if food and fluids were withdrawn

  • rate this
    +1

    Comment number 13.

    After reading this blog & previous ones like it, it just reinforces to me the wisdom of staying out of the hospital system if at all possible.
    And judging from several of the preceeding comments, eugenics is alive & well in 2011.

  • rate this
    +1

    Comment number 12.

    There is a right to life; problem arises when victim cannot speak his/her own wishes, which might be to enact the right to die.
    There is a right to life; therefore, it seems odd to me that we can exert this much energy over one person, but seem to care not about the thousands that are killed each day in war.

  • rate this
    +1

    Comment number 11.

    Preservation of life is correct, now we only have to define what life is!

    It baffles me how we can define lying in a semi-comatose state as being alive. As many people commented, there are people with better quality of life that are being allowed to die while M is being kept alive wholly artificially. We can justify painlessly euthanising other sentient beings - ie our pets, why not M?

  • rate this
    +1

    Comment number 10.

    Given the way that NICE refuses to provide life-prolonging drugs to cancer sufferers who are able to make the most of what life remains to them, what is their position on paying for long-term care of the profoundly comatose?

  • rate this
    +1

    Comment number 9.

    This is the out of touch with reality laws we get when religion is still controlling our government. Until we tax religions so their incomes are reduced, & therefore their investments on our stock markets are reduced, UK politicians/judges will remain scared of upsetting the mega rich religions who can threaten to pull out their billions from our stockmarket if they don't get what they want.

  • rate this
    +1

    Comment number 8.

    This is typical of our overpaid, pathetic, weak judges that he took the easy way out for himself. This lady should be allowed to die with dignity instead of having to endure a long, slow & painful death. We don't allow our animals to go through this so why allow it to happen to our loved ones ? It's about time UK judges grew a pair & made some decisions instead of always sitting on the fence.

  • rate this
    +1

    Comment number 7.

    We have a 'right to life' but what I really want to know is why we don't have a ''right to die'. Seems a bit odd to have one without the other if you ask me

  • rate this
    +1

    Comment number 6.

    Have you ever watched someone starve and dehydrate to death? If you havent, with the ageism and current healthcare we have in place in the UK, you probably will at some point. At least it only takes between 4 to 14 days depending on how weak your loved one is. Mine was conscious the whole time as her organs failed. She had a strong constitution so it took a while. Be careful what you wish for.

  • rate this
    0

    Comment number 5.

    With oil being used up at an exponential rate, oil costs rising exponentially due to the very low Energy Return on Investment of Energy (ERoIE) with falling stocks, no substitutes for oil, falling number of innovations (so we are unlikely to find substitutes) humans will overpopulate if we keep the 'right to life' the mainstay of medical science. We need to shorten lifespans for the benefit of all

  • rate this
    +1

    Comment number 4.

    Feeding tubes and hydration are routinely removed from elderly stroke patients. My grandmother was allowed to die without a court judgement, in this way, even though she was able to speak and was recovering her swallow reflex. She starved to death pleading for food. They also withdrew statins and hypertension treatment too. Be warned....its not a stroke that will kill you.

  • rate this
    +1

    Comment number 3.

    BEWARE STROKE My grandmother was euthanased at West Herts Hospital by removal of feeding and hydration following a stroke. She was given 2 weeks recovery time before the hospital decision. She was able to talk and showed signs of recovering her swallow reflex. I watched her starve to death pleading for food. The hospital didnt seek a legal judgement for this. This happens to stroke victims often.

  • rate this
    -2

    Comment number 2.

    "I will prescribe regimens for the good of my patients according to my ability and my judgement and never do harm to anyone." (5thC BC version) still governs medicine today in popular belief - it is a bit of a relief to see that the Court still agrees!

    We only have one life - the rest is dust and decay (sorry les religieuse) but that is the truth we all need to keep going as long as we can...

  • rate this
    +1

    Comment number 1.

    "if her room is made more comfortable and homely, her immediate surroundings will become more congenial and add to her pleasure in life."

    How can Judge Baker reasonably come to this conclusion; it might equally be true that M would like to die immediately? The truth is that this judgement will send shivers down the spines of millions who have expressed a wish to die if in a similar situation.

 

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