The Supreme Court’s recent judgment should prompt everyone to think about their future medical care
The recent judgment brings clarity to families and doctors of people in vegetative states – but also raises the importance of advance care planning, says Davina Hehir, Director of Policy and Legal Strategy at Compassion in Dying.
The Supreme Court confirmed last week in the Mr Y case that judicial approval is not always needed when withdrawing life-prolonging treatments from individuals with a prolonged disorder of consciousness (PDOC), such as minimally-conscious or persistent vegetative state.
Mr Y was a previously active man in his 50s who was left in a vegetative state after a heart attack that caused severe brain injury. The Supreme Court upheld an earlier High Court decision in Mr Y’s case that clinically assisted nutrition and hydration (CANH), a life-prolonging treatment, can be withdrawn from a person in a PDOC without having to seek permission at court, if the family and medical team agree that would be in the best interests of the person.
Compassion in Dying welcomed this decision as an important move towards more person-centred care. It means that in these tragic cases, what’s best for the individual can be decided by their medical team and loved ones, and be acted upon more quickly.
Families already struck by personal tragedy will be spared the added distress, bureaucracy and cost (legal aid is not available for these cases) of going to court and having to wait months or even years for a decision. It also brings much-needed clarity to doctors – previously, NHS trusts were forced to spend thousands of pounds bringing these cases, where there is unanimous agreement as to what is in the patient’s best interests, to court.
The judgment also made clear, however, that where there is a dispute within or between family and medical team about whether CANH is in the best interests of the individual, or where the medical evidence is finely balanced, cases will still go to court.
What has been lacking in much of the extensive media coverage of this judgment is that Mr Y’s court case would have been avoided entirely had he recorded his wishes around refusal of treatment before he fell unwell. If he had done so in a legally-binding way, his doctors would have been duty-bound to respect and follow his wishes.
We hope that this case will also raise public awareness of the benefits of planning ahead for your future medical treatment and care. Polling suggests that the majority of the British public have strong views about the treatment they would or would not want to receive, yet only a tiny minority have formally recorded their wishes in case they become unable to express them in future.
Whilst no one plans to have an accident or become unwell, there are things people can do now to help ensure that their wishes are be known and can be followed if tragedy does strike. Rather than leaving these choices up to family members, doctors, or the courts, who may disagree over what someone would have wanted, making an Advance Decision allows people to set out their preferences for medical treatment in different situations, in case they lose the capacity to make such decisions. People can also appoint a Lasting Power of Attorney (LPA) for Health and Welfare, to give a trusted person(s) the right to make such decisions on their behalf.
Lu Spinney, whose son Miles was left in a minimally-conscious state for five years following a snowboarding accident at the age of just 29, has become an outspoken advocate for planning ahead. “If only Miles had known about Advance Decisions”, Lu said when supporting Compassion in Dying’s Make It Your Decision campaign last year. “We could do nothing to help him out of a situation that we knew he would have done anything to avoid. I have since completed one myself and urged all of my loved ones to do the same.”
Compassion in Dying provides free, specialist information and support on how to talk about and plan for the end-of-life, to help avoid these devastating cases and ensure that people receive the treatment and care that’s right for them. Anyone is welcome to contact our Info Line (0800 999 2434), which is staffed by a specialist nurse, or access information online at www.compassionindying.org.uk