Mode of death in permanent vegetative state; human rights issues.
Professor Wade considers the possibility of killing patients in
permanent vegetative state for the sakes of relatives, health staff and
organ procurement. He opines that 'The situation is similar to treating
terminal distress in a conscious patient.'(1) For the benefit of lay
readers of the Journal I think it should be made very clear that killing
patients for the sake of others, with or without their consent and
including those in permanent vegetative state, is a criminal offence which
should not be contemplated. The analogy was unfortunate. However, his view
that death through omission of nutrition is unsatisfactory was shared by
an expert witness in the Bland case, and the Judge, Sir Stephen Brown,
allowed that sedative drugs could be given to Bland to minimise the
distressing response to this mode of death (2). Palliative drug treatment
for PVS patients who are no longer being nourished would seem therefore to
be legal, even if it is illogical.
Dame Elizabeth Butler Sloss considered two cases of proposed
withdrawal of artificial nutrition and hydration from patients in
vegetative states last year (3) when the Human Rights Act (1998) came into
force. She confirmed that the U.K. law established in Airedale NHS Trust v
Bland (1993) AC 789 is not incompatible with the European Convention on
Human Rights. Specifically, she confirmed that PVS patients are alive and
so Article 2 (Right to life) lays on the state a positive obligation to
refrain from taking that life intentionally, but no obligation to prolong
it. Importantly, she ruled that where a responsible clinical decision was
made to withhold treatment on the ground that it was not in the patient's
best interests, and that clinical decision was in accordance with a
respectable body of medical opinion, the state's positive obligation under
Art.2 of the Convention was discharged.
It is therefore crucial that medical opinions, especially as
expressed in prestigious medical journals, should at all times be
unambiguously stated and every effort must be made to maintain the respect
of the public.
1 Wade DT. Ethical issues in diagnosis and management of patients in
the permanent vegetative state. BMJ 2001; 322: 352-4
2 Airedale v Bland [1993] 1 All ER 821, 828.
3 NHS Trust A v Mrs M : NHS Trust B v Mrs H (2000) Times Law Reports
29/11/2000.
Rapid Response:
Mode of death in permanent vegetative state; human rights issues.
Professor Wade considers the possibility of killing patients in
permanent vegetative state for the sakes of relatives, health staff and
organ procurement. He opines that 'The situation is similar to treating
terminal distress in a conscious patient.'(1) For the benefit of lay
readers of the Journal I think it should be made very clear that killing
patients for the sake of others, with or without their consent and
including those in permanent vegetative state, is a criminal offence which
should not be contemplated. The analogy was unfortunate. However, his view
that death through omission of nutrition is unsatisfactory was shared by
an expert witness in the Bland case, and the Judge, Sir Stephen Brown,
allowed that sedative drugs could be given to Bland to minimise the
distressing response to this mode of death (2). Palliative drug treatment
for PVS patients who are no longer being nourished would seem therefore to
be legal, even if it is illogical.
Dame Elizabeth Butler Sloss considered two cases of proposed
withdrawal of artificial nutrition and hydration from patients in
vegetative states last year (3) when the Human Rights Act (1998) came into
force. She confirmed that the U.K. law established in Airedale NHS Trust v
Bland (1993) AC 789 is not incompatible with the European Convention on
Human Rights. Specifically, she confirmed that PVS patients are alive and
so Article 2 (Right to life) lays on the state a positive obligation to
refrain from taking that life intentionally, but no obligation to prolong
it. Importantly, she ruled that where a responsible clinical decision was
made to withhold treatment on the ground that it was not in the patient's
best interests, and that clinical decision was in accordance with a
respectable body of medical opinion, the state's positive obligation under
Art.2 of the Convention was discharged.
It is therefore crucial that medical opinions, especially as
expressed in prestigious medical journals, should at all times be
unambiguously stated and every effort must be made to maintain the respect
of the public.
1 Wade DT. Ethical issues in diagnosis and management of patients in
the permanent vegetative state. BMJ 2001; 322: 352-4
2 Airedale v Bland [1993] 1 All ER 821, 828.
3 NHS Trust A v Mrs M : NHS Trust B v Mrs H (2000) Times Law Reports
29/11/2000.
Competing interests: No competing interests