There was a dramatic new twist today in the case of a Muslim man said to be in a persistent vegetative state who doctors have indicated should not receive life-saving treatment if his condition deteriorates.
A QC for the family of "Mr L" from Greater Manchester told a High Court judge today that new video evidence has led an independent expert in neurology to conclude that he is "no longer in a persistent vegetative state".
The announcement came as the Pennine Acute Hospitals NHS Trust, which is responsible for the 55-year-old brain-damaged man's care, sought a declaration that it would not be in Mr L's best interests to offer him ventilation or resuscitation if there is "a life-threatening event".
The clinicians say Mr L would have "minimal prospects of improving neurological function" and no "meaningful quality of life" if life-prolonging treatment were given.
The family of Mr L are fighting the application and have insisted they have seen signs that he is not in a vegetative state.
The family also argues that, according to their religion, "life is sacred" and everything must be done to prolong life - including life-prolonging treatment, no matter the pain - "until God takes it away".
This morning Dr Peter Newman, independent expert in neurology, was due to give evidence which was expected to support the Trust's application for a declaration.
But Jenni Richards QC, for the family, told Mr Justice Moylan, that last night the family visited Mr L as normal but in the presence of a Trust doctor.
Although not a neurologist, the doctor produced overnight a witness statement in which he accepted there was a "closing of eyes and grimacing" when Mr L's eyes were cleaned.
Ms Richards said: "That video footage was viewed this morning by Dr Newman as well as by representatives of the family.
"On the basis of what he had seen on the video footage, Dr Newman's view, shared with all the parties, was that Mr L was no longer in a persistent vegetative state."
It was Dr Newman's position that he was now "most likely in a minimally conscious state", said Ms Richards.
"He accepts the video footage shows, as the family said, some purposeful responses - some sentient responses - on a different level from those that have previously been observed."
Ms Richards said that indicated that "further improvement is possible" for Mr L, who suffered a cardiac arrest in mid-July which resulted in severe brain damage.
The possibility could not be ruled that he could develop "beyond the minimally conscious state, although of course the nature of his brain injury means that he will always be severely incapacitated", said Ms Richards.
She said Mr Newman did not rule out the possibility eventually of "some verbal communication".
The overnight developments had the potential "to alter the care plan proposed by the Trust", said Ms Richards.
Claire Watson, appearing for the Trust, said that "clearly there has been a change in the diagnosis" which Dr Newman "has communicated to us this morning".
But it had not yet been possible "to obtain a definitive view from the treating clinicians at the hospital whether or not that will alter their care plan for L".
Ms Watson told the judge "it is unlikely to do so" in the light of the medical evidence given during the hearing, including in relation to the "severity of L's underlying brain injury".
Ms Watson added: "One cannot say with certainty but I anticipate that the position will not change."
Ms Richards said: "The Trust is, I understand, putting in process the arrangements for a multi-disciplinary meeting, including neurology."
Vikram Sachdeva, appearing for the Official Solicitor, who represents the interests of L, said "the position today has changed in a significant manner".
It was clear, he said, that the family's interpretation of L's movements were "probably accurate" and the Trust's assertion that there had been no meaningful movement was "probably not accurate".
He told the judge, sitting in the Court of Protection, that this "may not be something they can be blamed for".
"It may be he is much more responsive in the evenings when the family visits."
The experience in such cases was that patients "respond more readily to family".
Mr Sachdeva said: "Whether that makes a difference in terms of the ultimate outcome of the declaration sought by the Trust is a matter for exploration."
Speaking outside court after today's development, Helen Lewis, clinical negligence solicitor with Manchester-based firm Pannone, said on behalf of Mr L's family: "The family are pleased that the responses from L which they have witnessed have now been accepted in evidence by an independent expert.
"The Trust's clinicians now need to reassess the position in the light of the latest developments."