Editorials Patients' autonomy and values conflict with the responsibilities of clinicians

Withdrawal of life sustaining treatment

BMJ 2002; 325 doi: https://doi.org/10.1136/bmj.325.7357.175 (Published 27 July 2002) Cite this as: BMJ 2002;325:175
  1. Tom Sensky, reader in psychological medicine (t.sensky@ic.ac.uk)
  1. Imperial College of Science, Technology and Medicine, West Middlesex University Hospital, Isleworth, Middlesex TW7 6AF

    Ms B, as she was called in court and in the media, was a 43 year old professional woman who in 1999 had a haemorrhage in a cavernous haemangioma in her upper spinal cord. After an almost complete recovery she had a re-bleed in February 2001, which rendered her quadriplegic and dependent on artificial ventilation. Specialists who reviewed her all agreed that she had a negligible chance of substantial recovery, and she was advised to consider specialist rehabilitation. Ms B went to great lengths to gather information about her prognosis. She remained adamant that living on a ventilator would be intolerable to her because of the level of dependence on others and the lack of control over her own body she would have, and she requested to have her ventilation discontinued. The clinicians treating her felt unable to carry out her wishes, and Ms B eventually took to court the NHS Trust treating her.

    Dame Elizabeth Butler-Sloss judged that Ms B was indeed competent to decide on her treatment, and therefore her decisions about her treatment, whatever they were, must be respected.1 The judgment reviewed precedents for this, including the judge's own previous statement that “a mentally competent patient has an absolute right to refuse …

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