Law Report: Withdrawing patient's treatment is lawful: Airedale National Health Service Trust v Bland - Court of Appeal (Sir Thomas Bingham, Master of the Rolls, Lord Justice Butler-Sloss and Lord Justice Hoffmann): 9 December 1992.

Life sustaining artificial feeding and antibiotic drugs may lawfully be withheld from a patient in persistent vegetative state who has no hope of recovery if that is objectively and medically in the best interests of the patient, even though the patient would then die.

The Court of Appeal dismissed an appeal by the Official Solicitor, on behalf of Anthony David Bland, from declarations made by Sir Stephen Brown, President (the Independent, 20 November 1992) that the NHS trust might lawfully discontinue treatment designed to keep Anthony Bland alive in his persistent vegetative state.

Mr Bland, when aged 17-and-a- half, was injured in the Hillsborough football ground disaster in April 1989. His lungs were severely crushed and the supply of oxygen to his brain was interrupted. For three-and-a-half years he has suffered a condition known as persistent vegetative state, which is distinct from irreversible coma and brain death.

Mr Bland breathes unaided. He is incapable of voluntary movement, although capable of reflex movement. He has no cognitive function. He is fed by a nasogastric tube. Medical experts agree that there is no hope of any improvement or recovery.

The NHS Trust, with the concurrence of Mr Bland's family, applied for declarations that it was lawful to discontine treatment.

James Munby QC (Official Solicitor) as Mr Bland's guardian ad litem; Robert Francis QC, and Michael R Taylor (Solicitor, Yorkshire Health Authority) for the NHS Trust; Anthony Lester QC, and Pushbinder Saini (Treasury Solicitor) for the Attorney General as amicus curiae.

SIR THOMAS BINGHAM MR said that the case was not about euthanasia or putting down the old and infirm, the mentally defective or the physically imperfect, or eugenic practices. A profound respect for the sanctity of human life was embedded in our law and moral philosophy.

It was a civil wrong, and might be a crime, to impose medical treatment on a conscious adult of sound mind without his or her consent. A medical practitioner must comply with clear instructions given by an adult of sound mind as to the treatment to be given, whether those instructions were rational or irrational. Where an adult patient was mentally incapable of giving consent, no one, including the court, could give consent on his behalf. Treatment might lawfully be provided by a doctor where the treatment was in the best interests of the patient.

Where the patient was a child and a ward of the court, it would decide what was in the patient's best interests. The court might judge it to be in the child's best interest that life-saving measures be withheld if the life thereby prolonged would be one of intolerable pain and deprivation.

Mr Bland was not a child and ward, was immune to suffering and gave no instructions concerning his treatment if he were to become a PVS patient.

It did not seem crucial whether or not artificial feeding by nasogastric tube was regarded as medical treatment, since whether or not it was, it formed part of the patient's medical care.

The question whether artificial feeding and antibiotic treatment should be discontinued was one to be resolved by the doctors in charge, exercising a careful and informed judgement of what the best interests of their patient required. It was appropriate to take full account of the family's wishes.

The presumption in favour of prolonging human life was not irrebuttable. Mere prolongation of the life of a PVS patient was not necessarily in his best interests. In making an objective judgement of Mr Bland's best interests, account could be taken not only of pain and suffering which prolonged feeding and medication might cause, but also of wider, less tangible considerations.

The assessment of Mr Bland's best interests, although initially a matter for his doctors, was ultimately subject to the sanction of the court where its jurisdiction was invoked. There was no reason to impugn the doctors' judgement here. Unless the doctors' premises could be effectively challenged, there was no ground for withholding the court's sanction.

A doctor who discontinued artificial feeding of a PVS patient, after a lapse of time which entitled him to be sure that there was no hope of recovery, in pursuance of a conscientious and proper judgement that such action was in the patient's best interests, was guilty of no crime. That was not an unlawful act, the doctor lacked criminal intent, breached no duty and his act did not cause death. In cases of this kind application should be made to the court to obtain its sanction.

Lord Justice Butler-Sloss, concurring, said that factors, including the reality of Mr Bland's existence outweighed the abstract requirement to preserve life. The doctors had concluded that his best interests lay in not artificially prolonging his life.

Lord Justice Hoffmann, concurring, said the court's decision should be able to carry conviction with the ordinary person as being based not merely on legal precedent but also upon acceptable ethical values. A conflict between the principles of the sanctity of life and individual's right of self-determination might require a painful compromise to be made.

The concept of having a life had no meaning in relation to Mr Bland. He was alive but had no life at all. If Mr Bland was unable to express his choice, we should try our honest best to do what we think he would have chosen. In this extraordinary case, it was more likely Mr Bland would choose to put an end to the humiliation of his being and the distress of his family. It would show greater respect to allow him to die than to keep him grotesquely alive. Thus, in principle, it would be right to allow Mr Bland to die.

News
The Banksy image in Folkestone before it was vandalised
people
Life and Style
tech

Sales of the tablet are set to fall again, say analysts

Sport
football West Brom vs Man Utd match report: Blind grabs point, but away form a problem for Van Gaal
Arts and Entertainment
Gotham is coming to UK shores this autumn
tvGotham, episode 2, review
PROMOTED VIDEO
Have you tried new the Independent Digital Edition apps?
News
ebooksAn unforgettable anthology of contemporary reportage
News
i100
Arts and Entertainment
Bloom Time: Mira Sorvino
tvMira Sorvino on leaving movie roles for 'The Intruders'
News
First woman: Valentina Tereshkova
peopleNASA guinea pig Kate Greene thinks it might fly
News
Brian Harvey turned up at Downing Street today demanding to speak to the Prime Minister
news

Met Police confirm there was a 'minor disturbance' and that no-one was arrested

Arts and Entertainment
George Lucas poses with a group of Star Wars-inspired Disney characters at Disney's Hollywood Studios in 2010
films

George Lucas criticises the major Hollywood film studios

Voices
Chris Grayling, Justice Secretary: 'There are pressures which we are facing but there is not a crisis'
voices

Does Chris Grayling realise what a vague concept he is dealing with?

Life and Style
A street vendor in Mexico City sells Dorilocos, which are topped with carrot, jimaca, cucumber, peanuts, pork rinds, spices and hot sauce
food + drink

Trend which requires crisps, a fork and a strong stomach is sweeping Mexico's streets

Life and Style
The charity Sands reports that 11 babies are stillborn everyday in the UK
lifeEleven babies are stillborn every day in the UK, yet no one speaks about this silent tragedy
News
Blackpool is expected to become one of the first places to introduce the Government’s controversial new Public Space Protection Orders (PSPOs)
news

Parties threaten resort's image as a family destination

Life and Style
Northern soul mecca the Wigan Casino
fashionGone are the punks, casuals, new romantics, ravers, skaters, crusties. Now all kids look the same
Life and Style
gaming

I Am Bread could actually be a challenging and nuanced title

Latest stories from i100
Have you tried new the Independent Digital Edition apps?
Independent Dating
and  

By clicking 'Search' you
are agreeing to our
Terms of Use.

iJobs Job Widget
iJobs General

Year 5 Teacher

£80 - £140 per day: Randstad Education Leeds: Year 5 Teacher KS2 teaching job...

Software Developer

£35000 - £45000 Per Annum Pensions Scheme After 6 Months: Clearwater People So...

Systems Analyst / Business Analyst - Central London

£35000 - £37000 per annum + Benefits: Ashdown Group: Systems Analyst / Busines...

Senior Change Engineer (Network, Cisco, Juniper) £30k

£30000 - £35000 per annum + Benefits: Ampersand Consulting LLP: Senior Change ...

Day In a Page

Two super-sized ships have cruised into British waters, but how big can these behemoths get?

Super-sized ships: How big can they get?

Two of the largest vessels in the world cruised into UK waters last week
British doctors on brink of 'cure' for paralysis with spinal cord treatment

British doctors on brink of cure for paralysis

Sufferers can now be offered the possibility of cure thanks to a revolutionary implant of regenerative cells
Ranked seventh in world’s best tourist cities - not London, or Edinburgh, but Salisbury

Salisbury ranked seventh in world’s best tourist cities

The city is home to one of the four surviving copies of the Magna Carta, along with the world’s oldest mechanical clock
Let's talk about loss

We need to talk about loss

Secrecy and silence surround stillbirth
Will there be an all-female mission to Mars?

Will there be an all-female mission to Mars?

Women may be better suited to space travel than men are
Oscar Pistorius sentencing: The athlete's wealth and notoriety have provoked a long overdue debate on South African prisons

'They poured water on, then electrified me...'

If Oscar Pistorius is sent to jail, his experience will not be that of other inmates
James Wharton: The former Guard now fighting discrimination against gay soldiers

The former Guard now fighting discrimination against gay soldiers

Life after the Army has brought new battles for the LGBT activist James Wharton
Ebola in the US: Panic over the virus threatens to infect President Obama's midterms

Panic over Ebola threatens to infect the midterms

Just one person has died, yet November's elections may be affected by what Republicans call 'Obama's Katrina', says Rupert Cornwell
Premier League coaches join the RSC to swap the tricks of their trades

Darling, you were fabulous! But offside...

Premier League coaches are joining the RSC to learn acting skills, and in turn they will teach its actors to play football. Nick Clark finds out why
How to dress with authority: Kirsty Wark and Camila Batmanghelidjh discuss the changing role of fashion in women's workwear

How to dress with authority

Kirsty Wark and Camila Batmanghelidjh discuss the changing role of fashion in women's workwear
New book on Joy Division's Ian Curtis sheds new light on the life of the late singer

New book on Ian Curtis sheds fresh light on the life of the late singer

'Joy Division were making art... Ian was for real' says author Jon Savage
Sean Harris: A rare interview with British acting's secret weapon

Sean Harris: A rare interview with British acting's secret weapon

The Bafta-winner talks Hollywood, being branded a psycho, and how Barbra Streisand is his true inspiration
Tim Minchin, interview: The musician, comedian and world's favourite ginger is on scorching form

Tim Minchin interview

For a no-holds-barred comedian who is scathing about woolly thinking and oppressive religiosity, he is surprisingly gentle in person
Boris Johnson's boozing won't win the puritan vote

Boris's boozing won't win the puritan vote

Many of us Brits still disapprove of conspicuous consumption – it's the way we were raised, says DJ Taylor
Ash frontman Tim Wheeler reveals how he came to terms with his father's dementia

Tim Wheeler: Alzheimer's, memories and my dad

Wheeler's dad suffered from Alzheimer's for three years. When he died, there was only one way the Ash frontman knew how to respond: with a heartfelt solo album