Frank Almonte

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that permission from the courts is not necessary when doctors and family members agree that food and water should be withdrawn from a person in a minimally conscious or persistent vegetative state in order to end their life.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 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.”

“I recommend nutrition and hydration be withdrawn together, as sustaining hydration without nutrition may prolong M’s general suffering and any additional suffering from hunger, without any particular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along with pertinent laws, Jackson accepted the stance of the woman’s family and doctors that CANH should be withdrawn and that the woman be placed on palliative care.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 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 recognised 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.