The withdrawal of food and fluid – the right to die
There was an important case this week in the Supreme Court, which is the highest Court in the UK regarding the withdrawal of food and fluid for some people. This is changing the way that these matters are going to be dealt with in the future.
The first case of this kind was the sad case of Anthony Bland in 1993, he was a survivor of the Hillsborough disaster and was in a vegetative state, from which there was no chance of recovery, but as he was otherwise a fit young man at the time of the incident, he could have continued to live for years. He had even undergone surgery without the need for anaesthetic, as he was brain dead and did not feel pain. The case decided that it was in his interests to stop his food and fluid, so that ultimately, he would die, which is what happened.
Since then all other cases of minimally conscious patients go to the Court of Protection for a decision and each case is decided on its own merits. Every case is expensive both in money terms, but also for the distress that the hearings cause to the loved ones, in part because of listening to the medical detail and in part with the anticipation and unknown nature of litigation.
So what did the Supreme Court decide? In future all patients who are in either minimally conscious states or vegetative states can have food and fluid removed without the need to apply to the Court for an individual decision as long as both the family and the health authority agree that this is in the persons best interests. If there is any disagreement, then this case is not relevant and also if the person is not clinically in one of the relevant coma like states. If the criteria are fulfilled, then the person can be allowed to die following the withdrawal of food and fluid. Their death will be managed to ensure that they are not in pain or suffering in any way.
There are estimates that at any one time in the UK there are about 3,000 people that this case might be relevant to. The Court of Protection deals with around 1,500 new cases each year, with a legal cost of £50,000 to the health authority in each case, that £75m per year that the NHS can spend on something else, as well as end the distress to the families that the litigation causes.
There will still be cases that the Court has to decide on, those that do not fulfil the criteria of this case, in particular, when the family disagree. This is not a case of assisted suicide, as without this artificial support these people would not survive, the only reason they are alive is the medical intervention that keeps that so, but there will be no doubt arguments that it is a case of assisted dying. With no chance of recovery and no quality of life, I endorse the decision by the Court to make the situation easier for all involved, however heart wrenching that decision might be.