End of Life Law Flashcards
B v NHS Hospital Trust [2002]
Competent adults have right to refuse even life-sustaining treatment
Withdrawing life-sustaining treatment
Withdrawing life-sustaining treatment from definitely DYING patients is usually uncontentious → not in their best interests to prolong death and suffering
Criminal Liability
Health care professionals owe a duty to treat patients → will be potentially liable if they withdraw or omit a treatment.
BUT – duty TO treat will expire if further treatment is futile and therefore not in the patient’s best interests.
e.g., if patient has no consciousness (persistent/permanent vegetative state) continued treatment is regarded as futile.
Vegetative or Minimally Conscious Patients
If patient does not have mental capacity and has no binding advance decision under MCA 2005 → the question of whether treatment will be withdrawn is dependent on a number of factors.
Airedale NHS Trust v Bland [1933]
Act / omission distinction
Established that it is lawful to withdraw life-sustaining treatment if in their best interests BUT it is not legal to kill them with an injection
For future cases need distinct limitations:
Withdrawal of artificial nutrition and hydration required evidence that:
1. Every effort should have been made to provide rehabilitation for at least 6 months
2. Diagnosis of irreversible PVS should not be considered confirmed until at least 12 months after the injury
3. Diagnosis should be agreed by two independent doctors
4. Generally the views of the patient’s immediate family will be given great weight
NHS Trust A v M, NHS Trust B v H
Human Rights Concerns
Art 2: deprivation of life must import a deliberate act as opposed to an omission which results in death
Art 3: An insensate patient has no feelings and no comprehension of the treatment given → no ability to experience pain and suffering which underpins Art 3 argument.
Patients with Minimal Consciousness
Common Law developed → withdrawal of treatment might be acceptable if it is judged to be in the patient’s best interests.
Involves broad assessment of the patient welfare → what is best for the patient in medical, emotional, and moral terms.
Best Interests Test
s4 MCA 2005
Must not make decision merely on basis of persons age, appearance or aspect of his behaviour
Not be motivated by a desire to bring about patients death
Must consider:
- Patients past and present wishes and feelings
- Beliefs and values that would influence decision if he had capacity
- Other factors that he would consider
Must take into account: - Anyone named by the patient
- Anyone engaged in patients care
- Any donee of a lasting power of attorney
- Any deputy appointed by court
W v M and Others
Applying Best Interests
Court conducted balancing exercise - weighed up positives and negatives of her life
Baker J refused to accept that M’s experiences were wholly or even on the balance negative.
Despite evidence that the patient would not want to be kept alive → court decided she ought to be.
Thus → irrespective of evidence relating to M’s past wishes and feelings, the sanctity of life should be prioritised.
CONTROVERSIAL decision -> after this there was a reassessment of how far patients’ wishes and feelings should be considered when deciding best interests.
Aintree NHS Trust v James [2013]
Held: ‘strong presumption that it is in a persons best interests to stay alive’ although not an absolute principle.
‘Futile’ should mean having no therapeutic of beneficial purpose.
‘no prospect of recovery’ – for a patient not actively dying treatment which allows the patient to resume a quality of life which the patient would regard as worthwhile is more readily applicable.
Briggs v Briggs
Police officer left in ongoing disorder of consciousness -> minimally conscious state.
Family asked court whether it would be lawful to remove life-sustaining treatment.
Charles J held: accepted application that ANH (artificial nutrition and hydration) should be withdrawn from a minimally conscious patient on the basis that the evidence of P’s past wishes was sufficiently cogent and compelling.
Re Y [2018]
Do not need to go to court to get permission to withdraw life saving treatment if hospital and family agree it is not in the patients best interests to be kept alive.
Re M [2017]
Reaffirmed Re Y [2018]
Not mandatory to bring court proceedings to withdraw CANH when there is no conflict.
Must go if family disagrees with hospitals best interests decision to withdraw sustaining treatment
