The order by Mr Justice Baker was issued in a case involving a woman, who can be referred to only as "M". She has been in "a minimally conscious state" since suffering from swelling of the brain stem, which caused serious damage and wasting to the brain. The woman suffered the illness in 2003, when she was 43, and has been minimally conscious since then.
A mother is seeking a court's permission to withdraw life-sustaining artificial nutrition and hydration from her brain-damaged daughter. The woman, 53, who can only be referred to as "M" for legal reasons, is in a "minimally conscious state".
ROMA - I punti salienti della legge sul testamento biologico approvata oggi alla Camera, che per il varo definitivo dovrà tornare al Senato, sono almeno due: le dichiarazioni anticipate di trattamento non sono vincolanti per i medici ed escludono la possibilità di sospendere nutrizione e idratazione, salvo in casi terminali. Inoltre, sono applicabili solo se il paziente ha un'accertata assenza di attività cerebrale.
On the face of it, the decision by a High Court judge in the case of M is no surprise - few would have expected a ruling to allow a patient with any level of consciousness and feeling to die. But a closer inspection of the 76-page judgement shows that Mr Justice Baker did not find his decision a straightforward one.
W (by her litigation friend, B) v M (by her litigation friend, the Official Solicitor) and others [2011] EWHC 2443 (Fam). Read judgment. In the first case of its kind, the Court of Protection ruled that withdrawing artificial nutrition and hydration from a person in a minimally conscious state was not, in the circumstances, in that person’s best interests. The Court also made general observations for future cases.
The Supreme Court of Canada will go ahead later this year and set a legal framework for when patients in a vegetative state can be withdrawn from life support. The court rejected a request this morning from the family of a severely ill Toronto man, Hassan Rasouli, to withdraw the case from its docket on the grounds that Mr. Rasouli recently passed into a higher degree of consciousness.
A Canadian man who was believed to have been in a vegetative state for more than a decade, has been able to tell scientists that he is not in any pain. It's the first time an uncommunicative, severely brain-injured patient has been able to give answers clinically relevant to their care. Scott Routley, 39, was asked questions while having his brain activity scanned in an fMRI machine. His doctor says the discovery means medical textbooks will need rewriting. Vegetative patients emerge from a coma into a condition where they have periods awake, with their eyes open, but have no perception of themselves or the outside world.
A woman left with irreversible brain damage and diagnosed as being in a permanent vegetative state is to be allowed to die with dignity after a judge dismissed reports by two “shocked” therapy assistants that she may have repeatedly whispered the word "die". Mr Justice Roderic Wood, sitting in the Court of Protection in London, ruled that "J", 56, who suffered a catastrophic heart attack in September 2010, is in a permanent vegetative state (PVS) "with no sense of awareness and no prospect of recovery".
Clinical criteria for PVS will clearly need to be revised in the light of this information. However, this research does not answer deep ethical questions about what should be done. These patients have profound brain injuries and their lives are extremely restricted. How will we evaluate their desires? What should we do if they wish to die? We will still need to do the ethical work to evaluate the implications of what they want, particularly whether they wish to live or die. This is one step towards an answer to the question of how we should care for people with severe brain injuries, but it is not the solution. Not only do we need to know what they want, we also need to know how limited medical resources should be fairly distributed and what constitutes a rational desire to die.
The Supreme Court of Canada heard the case of Toronto patient Hassan Rasouli Monday, which centres on the complex and often deeply painful issue of who should decide end-of-life care. With an aging demographic, increased life expectancy and ever more sophisticated technological interventions, these kinds of cases will almost certainly become more frequent. This is a welcome chance for the country’s highest court to clarify how end-of-life treatment should proceed when a physician and a patient’s family disagree.
Although DJ's condition is in many respects grim, I am not persuaded that treatment would be futile or overly burdensome, or that there is no prospect of recovery. (a) In DJ's case, the treatments in question cannot be said to be futile, based upon the evidence of their effect so far. (b) Nor can they be said to be futile in the sense that they could only return DJ to a quality of life that is not worth living. (c) Although the burdens of treatment are very great indeed, they have to be weighed against the benefits of a continued existence. (d) Nor can it be said that there is no prospect of recovery: recovery does not mean a return to full health, but the resumption of a quality of life that DJ would regard as worthwhile. The references, noted above, to a cure or a return to the former pleasures of life set the standard unduly high.
National clinical guidelines on the care of people in a vegetative or minimally conscious state, following severe brain injury These long-awaited guidelines will be a major contribution to clinical and ethical standards of care for this group of patients, not only in the UK but internationally. For England and Wales, they provide much needed clarity on legal decision-making. You can buy a print copy of the guidelines (130 pp, £15) from our online shop, or download a free PDF below. The guidelines were developed by a panel of experts in the field, who have organised complicated and wide-ranging information into six coherent sections: 1 Defining criteria and terminology 2 Assessment, diagnosis and monitoring 3 Acute to longer-term management 4 Ethical and medico-legal issues 5 End-of-life issues 6 Service organisation and commissioning Each section is followed by a set of clear recommendations.