Miss B: A woman with much to offer but no desire to live

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The Independent Online

Miss B'S life may be nearing its end but she has left an indelible impression on all those involved in her case.

Miss B'S life may be nearing its end but she has left an indelible impression on all those involved in her case.

Her dignity, courage and cool assessment of her situation impressed the barristers, court officials and the judge. Her arguments were lucid and sensitive and she made a compelling witness for her cause – the right to choose her own destiny.

Even as Dame Elizabeth Butler-Sloss, handed down her decision yesterday, allowing Miss B, aged 43, to refuse further treatment, the judge said: "She is clearly a splendid person and it is tragic that someone of her ability has been struck down so cruelly. I hope she will forgive me for saying, diffidently, that if she did reconsider her decision, she would have a lot to offer the community at large."

Miss B will now be moved from the hospital where she has been looked after for the past 12 months – since a ruptured blood vessel in her neck left her paralysed and unable to breathe unaided – to a neighbouring hospital where the head of the intensive care unit, identified only as Professor B, has agreed to carry out her wishes and switch off her ventilator.

Dame Elizabeth made it clear yesterday that while she had found Miss B "entirely competent to make all relevant decisions about her medical care" that did not preclude her from changing her mind.

If Miss B does decide to ask the doctors to carry out her final wish, no one will be left unaffected by the gravity of the situation. Professor B told the court he had never been faced with a similar case before but felt it was his duty to do as his patients requested.

Her case is different from those of Diane Pretty and Annie Lindsell, sufferers from motor neurone disease who sought right-to-die court rulings, because they required active steps to end their lives. Ms Lindsell died in 1998 – before assistance was required but Ms Pretty is awaiting a decision by the European Court of Human Rights.

It is different also from the case of Hillsborough victim, Tony Bland, and similar patients in persistent vegetative state because they were incapable of deciding for themselves and there was dispute whether tube feeding and hydration – which was withdrawn allowing him to die – amounted to medical treatment.

No one disputes the ventilation necessary to sustain Miss B is medical treatment. If her ventilator is to be disconnected, she will be given an injection of a sedative combined with morphine to ensure that she does not suffer. Ten years ago, two American doctors described in the Annals of Internal Medicine disconnecting the ventilator of a 67-year-old man with post-polio syndrome which had left him paralysed.

They wrote: "A heavy feeling of intense emotion consumed both of us as we slowly injected midazolam (a sedative) and morphine. Within a minute or so, the patient turned slightly cyanotic [blue] and began to struggle. With trembling hands we pushed more midazolam and morphine. [The patient] seemed comfortable. He exchanged smiles with his daughter. We both felt a great heaviness and deep sense of anxiety. He did not struggle further. About 30 minutes passed, although it seemed like hours. The patient then gradually slipped into a coma. Fifty-three minutes after he was disconnected, we pronounced him dead."

Miss B, who has not been named, was born in Jamaica and came to Britain when she was eight. The court heard she had an unhappy childhood but achieved a degree in social science and social work, and a Masters degree in Public Policy and Administration.

She became a social worker, before being promoted to be head of the social work department in a hospital and principal officer for training and staff development.

Although she never married and has no children, she has a close circle of friends and a godchild to whom she is devoted. She is also a committed Christian. She accepted her doctors had the right to refuse to carry out her wishes personally but "I was angered at the arrogance and complete refusal to allow me access to someone that would," she said.

Dame Elizabeth concurred. The judge said she had "the greatest possible sympathy" for Miss B's doctors but said the managers of the NHS Trust should have sought another doctor, in another trust, prepared to meet her request. It was because of their failure to do so that the judge found Miss B had been treated unlawfully and she fined the trust a nominal £100 to mark the offence.

Miss B has already refused to terminate her own life, by switching off the ventilator herself. She told the court: "It could be seen as suicide. I have a godchild who is struggling with this ... it is not necessary to put people through that. It is also not necessary for my church to be worrying about whether it was suicide or not."

Did that not put her doctors – reluctant as they were to carry out her wishes – in an awkward position? Her response was forthright. "The way I see it, I had a job where I was head of department and we would have unusual things that we had never dealt with before – enormous press interest, which had huge ramifications – you deal with them. You are a senior manager and you deal with it. That is my experience. You certainly do not whinge to the client about how difficult it is for you. It is totally inappropriate."