A brain-damaged, minimally-conscious woman should not be allowed to die, a British High Court judge ruled today.
The case is thought to be the first time that a judge has been asked to rule on whether life-supporting treatment should be withdrawn from a person who is not in a persistent vegetative state but is minimally conscious.
Mr Justice Baker, who heard legal argument during a Court of Protection hearing in London in July, described the case as unique and said it raised “very important issues of principle”.
Relatives wanted life-supporting treatment withdrawn and said the woman, who turned 52 earlier this month, would not want to live “a life dependent on others”.
But a lawyer appointed by the High Court to represent the woman opposed the relatives’ application for nutrition to be withdrawn – arguing that she is “otherwise clinically stable”.
The local health authority responsible for commissioning her care also opposed the relatives’ application and said the woman’s life was “not without positive elements”.
Mr Justice Baker heard that the woman, who cannot be identified for legal reasons and was referred to as M in court, suffered profound brain damage in early 2003 after being diagnosed with viral encephalitis.
She was in a coma for several weeks and had been thought to be in a persistent vegetative state.
Doctors later concluded that she was in a minimally-conscious state – just above a persistent vegetative state.
The judge said M had "some positive experiences" and there was a "reasonable prospect" that those experiences could be extended.
A spokesman for M’s relatives’ lawyers said: “This is a very important judgment. The law has been clarified.”
Mr Justice Baker said today: "The factor which does carry substantial weight, in my judgment, is the preservation of life. Although not an absolute rule, the law regards the preservation of life as a fundamental principle."
He added: “M does experience pain and discomfort, and her disability severely restricts what she can do.
“Having considered all the evidence, however, I find that she does have some positive experiences and importantly that there is a reasonable prospect that those experiences can be extended by a planned programme of increased stimulation.
“Having weighed up all the relevant facts, I conclude that it is not in M’s best interests for artificial nutrition and hydration to be withdrawn and I therefore refuse the application.”
The judge added: "I realise that this decision will be a severe disappointment to members of M's family who have endured years of anguish during which they have demonstrated their deep devotion to M.
“I hope it would be of some comfort to the family that M will continue to be looked after in her current nursing home, which I have visited during the course of the hearing.
“All parties, including members of M’s family, agree that the care given to M at the nursing home is of the highest standard.
“I urge everyone concerned with M – doctors, care staff, and her family – to work together to agree a revised care plan which gives her an opportunity of more positive experiences.”
The court heard evidence from M's sister B and partner S.
B broke down as she described M's condition and told Mr Justice Baker why relatives wanted artificial nutrition and hydration withdrawn.
“She cannot enjoy a drink, a cup of tea or anything. She has got no pleasures in life,” B told the court.
“Just a daily routine of being taken out of bed, put in a chair and put back in bed. Shower, doubly incontinent. It is just awful. It’s not life. It’s existence. And I know she would not want that.”
Vikram Sachdeva, for relatives, said all parties involved accepted that relatives’ motives were based on “genuine respect for the interests of M”.
“This is an exceptionally sad case in which no one could doubt that M, her partner S, her mother W, and her sister B are deserving of the greatest sympathy,” Mr Sachdeva told the judge.
“The family are here because of the clearly and consistently expressed views of M, who was not religious, that she would never want to live a live dependent on others, even if she retained her mental faculties. But for that wish, the family would not be here.”
He added: “The issue in this case is whether M continuing to have medical treatment in the form of artificial nutrition and hydration is truly in her best interests...
“The (family) does not contend that all those in a minimally conscious state result in the balance of best interests to be in favour of withdrawal – simply that in some individual cases, after meticulous consideration of all factors for and against, that might be the most humane course and in the individual’s best interests.”
But the Official Solicitor – the lawyer appointed by the court to represent M - said withdrawing life-supporting treatment could be the start of a “slippery slope”.
“It is fundamental in this case to note that M is clinical stable,” Caroline Harry Thomas QC, for the Official Solicitor, told the judge.
“She has no need for other life-sustaining treatment. M’s life expectancy is 10 years ... M is not at the end of her life.”
Miss Harry Thomas said M showed a “range of behaviours and responses to external stimuli” and experts agreed that she had “awareness of herself and her environment”.
“Where, as in M’s case, a person is in a minimally conscious state and is otherwise clinically stable it cannot, as a matter of law, be in that person’s best interests to withhold or withdraw life-sustaining treatment, including artificial nutrition and hydration,” said Miss Harry Thomas.
“If it is not in M’s best interests to withdraw or withhold life-sustaining treatment, including artificial nutrition and hydration, were such treatment withheld or withdrawn, this would amount to the actus reus of murder.”
She added: “It cannot be in the best interests of an otherwise clinically stable person in a minimally conscious state to have life-sustaining treatment, including artificial nutrition and hydration, withdrawn. To do so would be to embark on a slippery slope...
“On the evidence, it is not in M’s best interests to withdraw and withhold life-sustaining treatment.”
Bridget Dolan, for the primary care trust (PCT) responsible for commissioning M’s care, said M had been in a care home since 2008 after being treated at specialist hospitals.
“On the factual evidence it appears to the PCT that M’s life is one that is not without positive elements,” she told the judge.
“The PCT notes the reports of staff that M can express emotion and appears at times to experience pleasure.”
She added: “It does not appear to the PCT that M’s condition is such that her life has no positive aspects to weigh against the discomforts she may at times experience...
“The PCT therefore wishes to continue to commission a comprehensive package of care for M and, in doing so, is keen to maximise the quality of life she experiences.”