This article focuses on a recent ruling (the background facts can be found here) by the Supreme Court, which addresses the current need for legal permission to end care for patients in a “long-term, permanent vegetative state”. The implications of this decision are massive; it could affect thousands of people who are kept alive by medical intervention. Undoubtedly, these cases can be distressing for doctors and judges alike. The stress can be especially apparent for the former when one considers the core values and principles set by the General Medical Council (GMC), which are similar to what many understand to be a “Hippocratic Oath”.
Article 2 of the European Convention of Human Rights (ECHR) gives those within the scope of the instrument the right to life. The right to life has been subject to much debate. These questions have multiplied over recent years, particularly with medical developments and understanding. In turn, this has led to cases (links are provided to the case summaries, courtesy of "Dignity in Dying") such as those of Debbie Purdy and Diane Pretty. Questions arise as to whether the right to life also includes “the right to die” and the ability to decide how one ends their own life. Many of these cases end up before the Supreme Court or the European Court of Human Rights (ECtHR) situated in Strasbourg.
Prior to the decision, such cases were dealt with by an application to the Court of Protection. The Court of Protection considers cases for those who are unable to represent themselves. The issues with this process were that it was lengthy and expensive. The process could take months or even years. Further, it costs health authorities approximately £50,000 in legal fees to appeal.
Lady Black gave the leading judgment (found here), which was unanimously agreed by the other judges, indicating that she did not believe that the common law nor the ECHR requires the court’s involvement to decide upon the best interests of every patient with a prolonged disorder of consciousness before clinically assisted nutrition and hydration can be withdrawn. Lady Black did, however, go on to state that an application would be best suited in situations where: each side are finely balanced, if there is a difference of medical opinion or if there is a lack of agreement about proposed action.
The most recent decision by the Supreme Court appears to follow on from the case of Airedale NHS Trust v Bland. In this case, the House of Lords allowed doctors to withdraw artificial nutrition and hydration. This was seen as an omission, not a positive act and one that was ‘in the best interests’ of the patient. Whether either judgment is used in future litigation to widen its use to other cases is yet to be seen. It is clear that the decision will, however, be subject to much debate and will divide the opinions of the general public, depending on their stance.