Court debates patient's right to die

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This was the strangest of hospital visits and perhaps one of the saddest. A bright-eyed, healthy-looking, intelligent woman surrounded by a posse of lawyers and court staff, pleading with a judge at her bedside to be allowed to die.

Never before had the High Court witnessed such a scene and never has it had to make such a difficult judgment over one so articulate and, paradoxically, so apparently full of life. If, as the paralysed patient wants, her ventilator is switched off, she will be dead within hours.

The drama was played out at a London hospital yesterday and relayed back to Court 38 of the Royal Courts of Justice in the Strand. There, journalists, lawyers and friends of the patient watched in silence as the surreal proceedings jerked in time-delay across three videolink screens.

The cameras seemed cruelly invasive; they showed the patient in bed, a blue tube leading from a ventilator into her neck, being cared for by intensive care unit staff, with a wipe of the brow here, the changing of a drip there. Sometimes she chatted, sometimes she laughed, but mostly she listened intently.

Throughout the 70-minute bedside hearing, the sound quality was poor, but what could be heard left no doubt that the patient is determined to end a life that has become intolerable since a ruptured blood vessel left her paralysed from the neck down more than a year ago. "I want to be able to die," she said.

Dame Elizabeth Butler-Sloss, president of the Family Division of the High Court, travelled to the patient's bedside with court staff, the woman's lawyers and the legal team of the hospital, which is fighting the case on ethical grounds. An order prevents the hospital, its staff, the patient and her family from being named.

At 10am, Dame Elizabeth entered the side-room in which the patient and the videolink machinery had been installed. The patient, a single former social care professional in her forties, was slightly elevated, a monitor to her left flickering continually with her vital life signs. Then, with gentle movements heavy with pathos, a court usher placed a Bible under her lifeless right hand for her to be sworn in.

Philip Havers QC, her barrister, asked whether she wished not to be ventilated any more. "That is right," she replied. Did she want to leave the hospital and be taken somewhere where her wishes could be carried out? "Yes," she said. And again she said "Yes" when asked whether the consequences of this had been explained to her by her doctors.

Robert Francis QC, representing the hospital, asked: "Is it your wish to die or is it your wish not to remain alive in your present condition?" She replied: "The latter."

Dame Elizabeth's task was clearly onerous. "You have, of course, challenged a very difficult area which is evolving and where perhaps the intervention of the courts may do some good," she told the patient, who replied: "I hope so."

The judge went on: "But you do realise that you have raised an issue which most people would wish to avoid having to deal with?" The woman responded: "Yes."

Dame Elizabeth told the patient that her job was simply to decide whether she was competent to make the decision to ask for her ventilator to be switched off. "It's then going to be entirely up to you what you want to happen next," she said. "I don't think it's for us to explore what you want to do, as long as you understand once we have all gone away and gone out of your life, you are tied by any decision that you make because the future of your life is in your hands."

When the hearing resumed at the High Court, the consultant responsible for the woman's care said the case was unusual because most intensive care unit patients were unconscious, whereas this one was awake, intelligent and highly articulate.

"It has become more than the usual doctor/patient relationship," she said. "Our main dilemmas were legal and ethical issues as to whether we could suddenly turn off the ventilator which would directly lead to her death."

Asked whether the medical team would be able to carry out the patient's wishes if the court ruled in her favour, the consultant replied: "I would have difficulties, because I have known the patient for over a year.

"This is a condition that can happen to anybody. The issue that arose in my mind is: what is left with this lady, what can we offer her? Every time I go to her bed, I think: what can I tell her to keep her happy, to give her some enthusiasm and carry on living? I'd had so many chats with her, I enjoy talking to her, but I just find it so hard to find anything to make her happy."

The hearing continues today.