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Disaster victim's coma release hinges on legal definition

FOR the third year running, Tony Bland yesterday spent his birthday in hospital, unaware that his parents had returned from holiday to visit him. Since the Hillsborough stadium disaster in 1989, Mr Bland, now 22, has been in a coma, kept alive by the actions of doctors who believe - like his mother and father - that he should be allowed to die, but fear they may be charged with murder if he does.

Mr Bland, who was crushed in the tragedy at the Sheffield Wednesday ground, can breathe unaided but cannot swallow. He is kept alive by fluids delivered through an intravenous drip and by food delivered into his stomach through a tube. His parents visit him regularly in his room at Airedale Hospital, near his home in Keighley, West Yorkshire, but long ago gave up any hopes of his recovery.

They would like the tubes to be disconnected, allowing their son to die in peace. But their wishes have been thwarted by the law's lack of clarity. Does the feeding tube constitute treatment? If so, Dr Jim Howe, Mr Bland's doctor, might escape prosecution: in some circumstances doctors can end medical treatment if the prognosis is hopeless, according to lawyers. If not, Dr Howe could be accused of starving his patient to death. Last week, the regional health authority, Yorkshire Health, said it was consulting lawyers about a possible High Court action to clarify the issue.

Every effort was made to revive Mr Bland in the months following the disaster. He was given physiotherapy two or three times a day. Friends talked to him, played music and surrounded him with football scarves, shirts and photographs. He never responded.

'He makes no purposeful responses or movements of any kind,' Dr Howe said. 'He does not make any eye contact. He doesn't blink. He cannot see or hear anything. He lies in the foetal position - which shows that his posture is not under the control of the higher centres in the brain. He cannot swallow, showing that major damage has occurred on both sides of the brain. He is in a permanent vegetative state.'

If people in this condition are going to recover they do so within three to four months. After six months there is no hope of recovery, Dr Howe said.

In the United States, Canada and Scotland people in this state are allowed to die by withdrawal of tube feeding if two doctors attest to their state and relatives do not object. When there are no relatives, permission is sought from proxies.

More than 1,000 such people in England and Wales are being kept alive because of the Home Office decision to endorse a prosecution of the first doctor to move out of line. It costs pounds 100m a year to keep them all alive.

'The beds could be used to provide kidney dialysis or other procedures for people who have a life to live. Treatment cannot help someone who is in the permanent vegetative state. The DPP decides not to prosecute in other cases where they know they have no chance of winning. Why can't they just take a decision not to prosecute in cases of this kind? The British Medical Association's ethical committee is looking into these cases and they will probably say that it is not right to keep these people alive, but the BMA could not recommend individual doctors to stop treatment.'

Tony Bland's parents, Allan Bland, 56, a warehouseman, and his wife Barbara, 54, have been sleeping at the hospital. They are victims of the Home Office's decision; they cannot hope for any improvement in their son's condition and they are not free to grieve his loss.

'We are trying to hold on to reality. Our thoughts are with our son and we are spending every moment we can at his side,' Mr Bland said.

(Photograph omitted)