Intended for healthcare professionals


Clinically assisted nutrition and hydration

BMJ 2018; 362 doi: (Published 13 September 2018) Cite this as: BMJ 2018;362:k3869
  1. Derick T Wade, professor of neurological rehabilitation
  1. OxINMAHR, and Movement Science Group, Oxford Brookes University, Oxford, UK
  1. derick.wade{at}

Landmark judgment returns decision making to clinical teams and families

The recent Supreme Court judgment given by Lady Black1 removed the requirement to obtain legal sanction for every decision to withdraw clinically assisted nutrition and hydration from people who lack capacity through “prolonged disorders of consciousness” (PDOC). This represents the culmination of a paradigm shift over the past six years, moving from a focus on a patient’s diagnosis and level of awareness to a focus on the patient’s best interests. It returns clinical decision making to the clinical team, including families.2 It removes the exceptionalism that has grown around this decision.

The judgment confirms that there is “no requirement in domestic law for an application to the court” and that “the combined effect of the MCA 2005 [Mental Capacity Act 2005], the Mental Capacity Act Code, and the professional guidance, particularly that emanating from the GMC [General Medical Council]” provides a sound, protective regulatory framework. Black concludes that existing law and guidance34 are sufficient to ensure good practice, primarily through using the best interests process.5

Turning to the previous emphasis on categorising a patient’s clinical state, Black also expressed “difficulty in …

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