Monday 8 July 2002

bulletThe right to die: when does the patient know best? 

A STORY unfolding in the High Court and a hospital ward shows a profound problem facing doctors, reports Celia Hall

It seemed at first that there was no legal reason why a rational, paralysed women kept alive by a ventilator, should have her right to die tested in a court.

But the moving story that unfolded in a hospital ward and later in the High Court yesterday clearly showed how her doctors face a profound problem contrary to all their teaching and their feelings as human beings.

The patient survives because she is being kept alive by medical treatment, a machine that breathes for her. She cannot move, or do anything for herself but her mental powers are not affected.

She has decided that she does not want to continue to live in that condition and wants to have her ventilator switched off.

As a competent adult she has every right to refuse treatment and given her intention, stated as long ago as last August, the hospital may even have acted illegally in not acceding to her wishes.

Treatment that a competent patient does not consent to is, in law, an assault.

This case has nothing to do with euthanasia or with physician assisted suicide in which a person seeks to take an action to end their life prematurely often with the help of another.

It is not the same as the case of Diane Pretty, who has motor neurone disease and wants her husband to be free from prosecution if he helps her to end her life. Her case failed in the English courts and she has taken it to the European Court of Human Rights.

In the case of the paralysed woman, her doctors said that they had got to know her over the year. Clearly they like her. The bond has gone beyond the doctor/patient relationship.

Her anaesthetist said yesterday that she did not want to take an action that would kill her patient. Her consultant told how she enjoyed talking to the woman, had many chats with her, but said how hard it was to find anything to make her happy.

Her doctors believe that if she was not in the intensive care unit but cared for in different, more normal surroundings, she might feel differently about wanting to live.

Dr Vivienne Nathason, head of ethics at the British Medical Association, recalled that the actor Christopher Reeve had begged people to let him die when he had learned the extent of his paralysis.

"Now he is glad that he didn't. We know that with psychological support and full rehabilitation and when people go home they can feel differently.

"But it seems to me that ethically and legally, if a patient is competent she has the right to say whether or not she wants life sustaining treatment," she said.

Dr Richard Nicholson, editor of the Bulletin of Medical Ethics, said it was unusual for such a case to go to court.

"Perhaps her doctors wanted the position cleared so that no one could be accused of taking part in a physician assisted suicide." he said.

Unlike cases of persistent vegetative state (PVS) when the patient was in a coma, this woman was conscious. "Doctors can find it very hard to let go," he said.

Since the case of Tony Bland in 1993 when the Law Lords ruled that doctors could withdraw hydration and nutrition, the cases of about 15 other PVS patient have been taken to court.

The patients whose views could not be sought have been "allowed" to die in the same way.

(Filed: 07/03/2002) Copyright of Telegraph Group Limited 2002. Terms & Conditions of reading. Commercial information. Privacy Policy.

For more information on this case see 'We can't pull the plug on a conscious patient we have known for a year' By Celia Hall, Medical Editor (Filed: 07/03/2002)

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