Withdrawal of Life-Sustaining Treatment – Who Decides?
Should decisions to withdraw life-sustaining treatment be made by a patient’s loved ones, in consultation with doctors, or by judges? The High Court tackled that burning issue in the case of a Huntington’s disease sufferer who had for years been in a minimally conscious state.
The inherited condition, which leads to the inexorable death of brain cells, had left the mother of two incapable of recognising members of her family. She had been hospitalised for more than 20 years and her mother, who visited her four times a week, had described her as rarely awake. Doctors could only speculate as to her level of awareness and the extent of her suffering.
In those circumstances, the hospital that cared for her applied to the High Court for a declaration that it would be lawful to withdraw the clinically assisted hydration and nutrition on which she depended. The Court granted the relief sought and the woman died peacefully, aged 50, about two weeks after treatment was withdrawn.
In finding that the hospital’s application, whilst understandable, was unnecessary, the Court noted that treating clinicians and the woman’s family were unanimous in their views that further treatment would not be in her best interests. Given that agreement and the particular facts of the case, the decision to withdraw treatment could lawfully have been taken without judicial intervention.
The Court noted that costly and time-consuming proceedings in such cases are not mandatory and could have a deterrent effect. Clinicians and families could be deflected from making true best interests decisions and there was a risk that inappropriate treatment might be continued by default. In the present case, treatment that neither doctors nor the woman’s family considered to be appropriate was persisted with for almost a year before a judicial decision was sought.