Pro-life campaigners mourn defeat in Britain's Supreme Court (The Economist Aug 2nd 2018) 尊厳死
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In June 2017 Mr Y, an active man in his fifties, suffered a heart attack and extensive brain damage. He died later that year, having failed to regain consciousness. In the final months of his life, the NHS trust responsible for his care went to court to clarify the law. His family believed he would not have wanted treatment to keep him alive; the trust wanted to know whether it need judicial approval to withdraw sustenance (known as “clinically assisted nutrition and hydration”, or CANH), given that doctors agreed doing so was in his interests.
On July 30th the Supreme Court ruled that no such approval was needed. Families will now end up in court only when they are divided over what a relative would want, or when they disagree with their doctors’ views.
Many people may be affected by the decision. Improvements in medicine mean people are increasingly likely to survive events that leave them in vegetative or minimally conscious states. A rough estimate by Derick Wade, a professor of neurological rehabilitation at Oxford Brookes University, suggests that as many as 50,000 people in Britain may be in such a condition. The court’s judgement also applies to those who are conscious but unable to swallow and make a decision, of whom there are more.
The decision built on one in 1993 by the House of Lords. It ruled that CANH was a medical treatment, meaning it could be withdrawn if doctors and family agreed it was no longer in the patient’s interests. But it suggested applications ought to be made to the High Court to get the go-ahead. Since then, fewer than 200 such applications have been made. Celia Kitzinger of Cardiff University expects withdrawal of CANH to become more common now that there is no need to navigate the courts. Pro-lifers worry about this. Alistair Thompson of Care Not Killing, a campaign group, says that, though the old system had flaws, “the added layer of protection was sensible.”
The Supreme Court ruled that decision in 1993 was “no more than a rule of practice”, and that there was no breach of the human rights in withdrawing CANH if continuation was not in their interests. It noted that withdrawing CANH was common in cases with patients suffering degenerative neurological conditions, and saw no reason to treat those in a stable condition differently. It also accepted that the need to go to court might have led families and doctors to make the wrong decision in some cases.
There is reason to think this is true. The belief that court approval was needed meant doctors often felt absolved of responsibility for decisions, which led to “inertia”, says Ms Kitzinger. Moreover, NHS trusts that went to court to withdraw CANH faced a lengthy, complex and expensive process. All of this meant that it was mostly to families to push for withdrawal. The British Medical Association, which represents doctors, is now expected to issue guidelines saying it should not be up to families to ensure regular assessments of whether treatment is in a patient’s interests.
The court’s decision is part of continuing shift away from a legal system based on the idea of the “sanctity of life”, towards one based on “patients’ autonomy”, says Thomas ?Davies of Dignity in Dying, another campaign group. His organization hopes that another change is on the way. It is supporting an appeal to the Supreme Court by Noel Conway, a sufferer of motor-neurone disease, who argues that his inability to receive help from a doctor to die infringe his human rights. The court is expected to decide whether to hear the appeal by mid-October. If it does, a more radical reconsideration of the rules around death could yet be to come. ?
