Intended for healthcare professionals


Human Rights Act does not affect the law on PVS

BMJ 2000; 321 doi: (Published 14 October 2000) Cite this as: BMJ 2000;321:916
  1. Clare Dyer, legal correspondent
  1. BMJ

    The Human Rights Act does not affect doctors' right to withdraw artificial nutrition and hydration from patients in a permanent vegetative state (PVS), England's senior family judge ruled last week.

    Dame Elizabeth Butler-Sloss, president of the High Court's family division, gave the go-ahead for tube feeding to be withdrawn from two patients. She held that the principles laid down by the House of Lords seven years ago in the Bland case were not affected by the Human Rights Act.

    The act, which came into force last week, incorporates the European Convention into UK law, making it enforceable in the UK courts. Article 2 of the convention, the right to life, places a positive obligation on the state to safeguard life.

    Around 20 patients in a permanent vegetative state (previously referred to as persistent vegetative state) have been allowed to die since the Bland case in 1993, which established that treatment that confers no benefit on a patient—including artificial nutrition and hydration—may be discontinued.

    But the law had to be reconsidered in the light of the new “right to life” provisions. The case concerned two women patients identified in each case by a single initial.

    Mrs M, aged 49, has been in a permanent vegetative state for three years after an anaesthetic mishap during a gynaecological operation outside Britain.

    Ms H, aged 36, who has been epileptic all her life, had a cardiac arrest while in hospital undergoing treatment for pancreatitis. She has been in a permanent vegetative state only since last January—when the incident occurred—but doctors had experienced frequent problems with her feeding tube. It had become blocked on 23 September and doctors were unable to unblock it. She was receiving only subcutaneous hydration and drugs.

    The families of both patients wanted them to be allowed to die. John Grace QC, for the NHS trusts caring for the women, both in the north of England, and Ben Emmerson QC, appointed by the Official Solicitor to represent the patients, agreed that the principles laid down in the Bland case were compatible with the human rights convention.

    After two days of legal submissions and evidence, Dame Elizabeth made a declaration that artificial feeding was not in the patients' best interests and could be withdrawn. Mr Grace said the women were “victims” of medical technology that did not exist when the human rights convention was drawn up in 1950.

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