Court decision no longer required in right-to-die cases, judge rules

Legal permission will no longer be required by a court before life-supporting treatment is withdrawn from patients with severely debilitating illnesses, a high court judge has ruled.

The landmark ruling by Mr Justice Peter Jackson in the court of protection marks a significant change in how right-to-die cases may be handled in future by hospitals and families.

As long as doctors and relatives of the patient are in agreement and medical guidelines have been observed there is no need to bring a lengthy case to obtain judicial authorisation, Jackson declared.

His judgment was immediately welcomed by Compassion in Dying as a helpful step towards better end-of-life care. The official solicitor, who intervened in the case, is, however, likely to appeal against the decision.

The case centred on a woman, identified only as “M”, who had Huntington’s disease, a crippling genetic condition for which there is no cure. She was said to have been in a minimally conscious state in a Midlands hospital. Unusually, her mother, who supported the application to withdraw her feeding tube, was allowed to be her official “litigation friend” in the case.

The request for life-sustaining treatment to be ended was heard in April. The judge gave permission in June. On 24 July, her clinically assisted nutrition and hydration (CANH) was stopped and she died, aged 50, on 4 August. She had had the disease for more than 25 years.

The judge’s reasoning concerning the need for similar future cases is extremely significant. Jackson said: “On the facts of this case, I do not consider it to have been a legal requirement for the decision to withdraw CANH to have been taken by the court.”

He added: “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.

“Indeed, the present case stands as an example, in that M received continued CANH that neither her doctors nor her family thought was in her best interests for almost a year until a court decision was eventually sought.”

His ruling affects those deemed to be in persistent vegetative or minimally conscious states. Such cases where both doctors and all family members agree usually incur legal costs of about £30,000, Jackson said.

The official solicitor, a government official appointed to act for such patients, has argued that every case should come before the courts. The first case was that of Anthony Bland, a Hillsborough victim who had been in a coma since 1989. Permission was eventually granted for doctors to end his life-prolonging treatment in 1993.

Caroline Barrett, a human rights solicitor at the law firm Irwin Mitchell that represented M’s family, said: “Our client’s family witnessed a much-loved daughter, wife and mother deteriorate to the point where she no longer seemed to be aware of the world around her, or recognise her loved ones who regularly visited her in hospital and helped care for her.

“Huntington’s disease is an extremely cruel disease and when her condition reached the point when she had no quality of life remaining, and appeared unaware of the world around her, her family felt that her feeding tube, which was keeping her alive, should be withdrawn.

“This judgment has great legal significance in that if relatives and doctors are in agreement, and after following the medical guidelines issued by the Royal College of Physicians it is agreed that withdrawal of treatment is in the patient’s best interests, the court has confirmed that there is no legal requirement for a court order before the treatment can be withdrawn.”

Sarah Wootton, the chief executive of Compassion in Dying, said: “[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.

“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.”

She added that recording wishes in an advanced decision or advanced statement remained the best way for people to avoid costly and complicated court hearings over a patient’s wishes.