Miss B: There is nothing odd or bizarre about her reasons

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The Independent Online

The case of Miss B is about the right to choose, not the right to die. It is about the right of any patient who is medically competent to refuse treatment, however odd, irrational or bizarre their reasons may seem.

The case of Miss B is about the right to choose, not the right to die. It is about the right of any patient who is medically competent to refuse treatment, however odd, irrational or bizarre their reasons may seem.

There is nothing odd or bizarre about Miss B's reasons. Quite the contrary. After careful consideration of all the evidence, based on her own expert knowledge (she was a professional social worker in a hospital) she does not consider the life she can look forward to is worth living.

The power with which she developed her argument was, paradoxically, what made it so difficult for her doctors to accept. Most patients in whom the withdrawal of ventilation is being considered are moribund. Miss B is anything but moribund. Her body may be useless but her mind has lost nothing of its acuity, its sensitivity or its vivacity. Who could contemplate switching it off?

Yet those responsible for Miss B's care were wrong and badly wrong in refusing her request. It is understood that the doctors involved sought advice from the British Medical Association about how they should handle the case. They were given chapter and verse about the patient's right to refuse treatment – but it appears they were more concerned with her impertinence at not accepting their view of what was in her best interests.

The key point that yesterday's judgement has established is there can be no ethical distinction between starting treatment and stopping it. If patients have the right to refuse treatment, as they do, then they must have an equal right to order that a treatment be withdrawn after it has started.

Otherwise, patients could be faced with the appalling prospect that, once chosen, they could be stuck with a treatment. Doctors would be handing out one-way tickets and it could lead to patients refusing treatments in advance for fear they could not get off them.

In Miss B's case, the treatment was ventilation. There is no argument that ventilation is a "medical treatment" (even the Medical Ethical Alliance, an anti-euthanasia group, accepted that yesterday and tacitly acknowledged Miss B's right to refuse it).

It has long been accepted that treatment, even life saving treatment, requires the consent of the patient, where they are conscious and competent, before it may be given. Administering treatment without consent amounts to an assault. Hence Dame Elizabeth's nominal fine imposed on the NHS trust for "unlawful trespass."

The treatment of Jehovah's witnesses who refuse blood transfusions has frequently faced doctors with this dilemma. In 1994, doctors from the John Radcliffe hospital in Oxford described in the British Medical Journal how a Jehovah's witness seriously injured in a car accident died after refusing a transfusion. The doctors did not have the right to overrule his wishes, even to save his life.

In a recent case, the appeal court ruled a pregnant woman was entitled to refuse a Caesarean, even though the likely outcome was the death of the woman and her baby. The woman had been suffering from pre-eclampsia, a condition leading to high blood pressure that threatened her own life and that of her baby.

When she refused the offer of a Caesarean, her doctors called in a psychiatrist who had her sectioned under the mental health act and the operation went ahead. She later sued the hospital for assault and won on appeal.

After the case, Dame Elizabeth issued guidelines that the courts would no longer approve surgery without the patient's consent.

There can be no criticism of Miss B's doctors for refusing to carry out her request to switch off her ventilator and, therefore, let her die. But they erred when they refused to refer her to someone who would.