Patients' rights at end-of-life: the philosophical against the personal

Friday, 4 December 2015

A judge has ruled that a daughter can give consent to refuse treatment on behalf of her mother in a ‘vegetative state’.

A Judge in a Court of Protection hearing in the UK has ruled that the daughter of a cognitively and speech incapacitated patient in a vegetative state, as a consequence of the progressive degenerative impact of Multiple Sclerosis, can give consent on behalf of her mother to refuse treatment. The judgement covers very important law, policy and clinical guidelines linked with end-of-life decision making processes and particularly the patient’s consent. 

This judgement is not concerned with a right to die. No such right exists. It is about the patient’s right to live her life at the end of her days in the way that she would have wished. The judge evaluated the ‘inviolability of life’ as an ethical concept and weighed that against a patient’s right to self-determination or personal autonomy. 

The judge had to wade through complex case law and ethical frameworks (all listed in the judgment) to balance ‘inviolability of life’ versus the patient’s right to self-determination or personal autonomy in assessing the patient’s best interests. Through her daughter and other evidence, the judge assessed what the patient was before entering a vegetative state: what her circumstances, views and attitudes were. 

The daughter wanted to stop life sustaining treatment by means of Clinically Assisted Nutrition and Hydration (CANH), being given through a percutaneous endoscopic gastrostomy (PEG) tube, on the basis that the continuation of this intervention is contrary to her mother’s best interests. Her mother lacked capacity to litigate or indeed in any aspect of decision making.

The official ruling

Find out more in the official ruling here.