Court Decision is no Longer Needed in Right-to-Die Cases, says Judge

Legal permission is no longer needed to end care for patients in a permanent vegetative state, a judge has ruled.

The landmark decision by Mr Justice Peter Jackson is a significant change in how right-to-die cases may in future be handled by doctors and families in England and Wales.

Mr Justice Jackson said that if medical professionals and the patient's family can agree and if medical guidelines are satisfied, then life-sustaining treatment can be withdrawn from those in a vegetative state without the need for a court order.

For nearly 25 years, such decisions have been referred to the Court of Protection, even if doctors and family members were in agreement to withdraw the patient's treatment.

Mr Justice Jackson delivered his ruling in a case concerning a 50-year-old woman who had suffered from a degenerative illness for 14 years.

The patient, known in court as M, had Huntington's disease, a genetic condition for which there is no cure, and was confined to a bed in hospital and fed by a tube.

She had shown no sign of awareness for 18 months, the court heard, and Mr Justice Jackson agreed with her family and doctors that withdrawing nutrition from her would be in her best interests.

Her clinically assisted nutrition and hydration (CANH) was stopped and she died 11 days later.

‘Case should not have come to court’

Mr Justice Jackson said in his view the case should not have come to court.

"The 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," the judge said.

"On the facts of this case, I do not consider it to have been a legal requirement for the decision to withdraw [clinically assisted nutrition and hydration] to have been taken by the court,” he added, noting: “There was no statutory obligation to bring the case to court . . . A mandatory litigation requirement may deflect clinicians and families from making true best-interests decisions and in some cases lead to inappropriate treatment continuing by default.”

The Official Solicitor, the lawyer appointed by the state who is tasked with advocating in the courts for people who cannot do so themselves, is expected to appeal against the ruling, saying there was no evidence in patient M's medical records that she had made known her wishes about whether or not she wished to die.

Compassion in Dying welcomes ruling

Sarah Wootton, the chief executive of Compassion in Dying, an organisation who helps to ensure peoples’ wishes are respected at the end of their lives, welcomed the judge’s ruling, saying:

“[This] is a helpful step towards a clearer, more person-centred view of end-of-life care. 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.”

She went on to say: “While the judgment is likely to be contested by the official solicitor, we believe Mr Justice Peter Jackson’s reasoning is sound. It should not be necessary to require court proceedings to respect a person’s wishes simply because they are in a persistent vegetative state or minimally conscious state.”

Research by the BBC carried out in 2016 established that there were 105 patients in England and Wales in permanent vegetative or minimally conscious states. Many of the patients were found to have been in this state for more than six months and one patient had been in such a condition for more than 20 years.

Court of Protection

IBB Solicitors has niche expertise on applications to the Court of Protection and three of our solicitors are members of the Court of Protection's panel of professional deputies. For advice, contact a member of the Wills, Trusts and Probate team, call us on 03456 381381 or email enquiries@ibblaw.co.uk.