Judge over-rules family's wish that patient should be allowed to dieBMJ 2006; 333 doi: https://doi.org/10.1136/bmj.39041.664433.DB (Published 23 November 2006) Cite this as: BMJ 2006;333:1089
England's senior family judge has ruled that a woman in a persistent vegetative state (PVS) should be given a sleeping pill that has been reported to temporarily wake up PVS patients, despite the wishes of her family that she should be allowed to die with dignity.
Mark Potter, president of the High Court's family division, backed the official solicitor, acting for the 53 year old woman, who argued that the drug zolpidem should be given a brief trial before a final decision was made to discontinue artificial nutrition and hydration.
The woman, who cannot be named, is in a PVS after she had had a brain haemorrhage in August 2003 while on holiday with her family.
The official solicitor took expert advice after reading reports of cases where patients in a PVS temporarily woke up and in some cases spoke after being given zolpidem.
The woman's family were against the move because they thought it would be in her best interests to be allowed to die rather than to live with severe disabilities and to be aware of her condition.
A study in NeuroRehabilitation in May (2006;21:23-8) looked at the effects of the drug for up to six years on three men who had been given a diagnosis of PVS after traffic crashes. The effects tended to last up to four hours at a time. But experts caution that the men may not have been in a PVS.
Before making his decision Sir Mark considered evidence from Keith Andrews, who looks after severely brain damaged patients at the Royal Hospital for Neuro-disability in London. Dr Andrews said that, in his opinion, if the patient responded to the drug it would show she had never been in a PVS. He questioned whether the three patients in the study were actually in a PVS.
He added: “I saw no disadvantage to the patient of trying the drug. I have tried it on three patients with no effect at all.”
A spokesman for the Department for Constitutional Affairs, the government department that oversees the official solicitor, said, “It is a very difficult situation. The official solicitor, who represents the woman, came to a view that was opposite to the family.
“He accepts that there are incredibly sensitive issues that need to be addressed with this family. But he also takes the view that there are other issues for other patients in this situation. He believes that no stone should be left unturned in trying to save life.”
The drug is likely to be tried in future cases where doctors and families apply for court sanction to withdraw artificial nutrition and hydration from patients in a PVS.
A trial of zolpidem in brain damaged patients, not including patients in a PVS, is expected to start soon in South Africa. Ralf Clauss, a consultant in nuclear medicine at Royal Surrey Hospital, Guildford, who is involved in the trial, said that the drug seems to revive dormant brain cells in patients who respond to it.