Ministers ignored peers' call for new legislation

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Relatives of patients who cannot express their own wishes have to embark on complex legal actions because the Government ignored the advice of the Law Lords to introduce legislation giving guidelines to doctors, families and lawyers.

Seriously ill patients who can speak or write can ask for treatment to end but where patients are unconscious, or too young, others have to decide for them. This means the law is evolving case by case to take account of advances in medical technology which allows life to be sustained for longer.

The House of Lords is likely to have to consider many more cases, considering each time the exact conditions of the victim, but also his or her wishes in advance.

The Law Lords' recommendations came after the case of Tony Bland, a victim of the 1989 Hillsborough stadium disaster, who was left brain-dead after being crushed. They were backed by the Government's legal advice body, the Law Commission, which said three months ago that the mixture of statute and case law has a "number of unclear and incoherent answers" to what should be done where patients cannot decide for themselves. The commissioners spent five years consulting the medical and legal professions and said there should be a single court to decide disputes about treatment. A new law should be introduced to make it easier for doctors and families to decide when to end treatment for terminally ill patients. Commissioners recommended a single piece of legislation covering people who lack mental capacity to decide for themselves. There should be a new general rule that anything done for such people should be in their "best interests".

Doctors should take into account the past and present wishes of the patient and the wishes of anyone given power of attorney, and of a spouse, relative or friend who has been caring for the patient.

The issue was brought to a head by the case of Tony Bland, who was kept alive by tube feeding; the key decision was whether this was medical treatment.

In spite of his parents' wishes that treatment should end, he was not allowed to die until the House of Lords ruled on his case four years later. The Lords finally ruled that his interests would not be served by continuing the "futile" treatment.