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.

Start your day with The Independent, sign up for daily news emails
Latest stories from i100
Have you tried new the Independent Digital Edition apps?
SPONSORED FEATURES
Independent Dating
and  

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

iJobs Job Widget
iJobs General

Recruitment Genius: Project Assistant

£17000 per annum: Recruitment Genius: They are a leading company in the field ...

Recruitment Genius: DBA Developer - SQL Server

£30000 - £35000 per annum: Recruitment Genius: This is an exciting opportunity...

Recruitment Genius: Office Manager

£26041 - £34876 per annum: Recruitment Genius: There has never been a more exc...

Recruitment Genius: Travel Customer Service and Experience Manager

£14000 - £17000 per annum: Recruitment Genius: The fastest growing travel comp...

Day In a Page

Turkey-Kurdish conflict: Obama's deal with Ankara is a betrayal of Syrian Kurds and may not even weaken Isis

US betrayal of old ally brings limited reward

Since the accord, the Turks have only waged war on Kurds while no US bomber has used Incirlik airbase, says Patrick Cockburn
VIPs gather for opening of second Suez Canal - but doubts linger over security

'A gift from Egypt to the rest of the world'

VIPs gather for opening of second Suez Canal - but is it really needed?
Art of the state: Pyongyang propaganda posters to be exhibited in China

Art of the state

Pyongyang propaganda posters to be exhibited in China
The male menopause and intimations of mortality

Aches, pains and an inkling of mortality

So the male menopause is real, they say, but what would the Victorians, 'old' at 30, think of that, asks DJ Taylor
Blairites be warned, this could be the moment Labour turns into Syriza

Andrew Grice: Inside Westminster

Blairites be warned, this could be the moment Labour turns into Syriza
HMS Victory: The mystery of Britain's worst naval disaster is finally solved - 271 years later

The mystery of Britain's worst naval disaster is finally solved - 271 years later

Exclusive: David Keys reveals the research that finally explains why HMS Victory went down with the loss of 1,100 lives
Survivors of the Nagasaki atomic bomb attack: Japan must not abandon its post-war pacifism

'I saw people so injured you couldn't tell if they were dead or alive'

Nagasaki survivors on why Japan must not abandon its post-war pacifism
Jon Stewart: The voice of Democrats who felt Obama had failed to deliver on his 'Yes We Can' slogan, and the voter he tried hardest to keep onside

The voter Obama tried hardest to keep onside

Outgoing The Daily Show host, Jon Stewart, became the voice of Democrats who felt the President had failed to deliver on his ‘Yes We Can’ slogan. Tim Walker charts the ups and downs of their 10-year relationship on screen
RuPaul interview: The drag star on being inspired by Bowie, never fitting in, and saying the first thing that comes into your head

RuPaul interview

The drag star on being inspired by Bowie, never fitting in, and saying the first thing that comes into your head
Secrets of comedy couples: What's it like when both you and your partner are stand-ups?

Secrets of comedy couples

What's it like when both you and your partner are stand-ups?
Satya Nadella: As Windows 10 is launched can he return Microsoft to its former glory?

Satya Nadella: The man to clean up for Windows?

While Microsoft's founders spend their billions, the once-invincible tech company's new boss is trying to save it
The best swimwear for men: From trunks to shorts, make a splash this summer

The best swimwear for men

From trunks to shorts, make a splash this summer
Mark Hix recipes: Our chef tries his hand at a spot of summer foraging

Mark Hix goes summer foraging

 A dinner party doesn't have to mean a trip to the supermarket
Ashes 2015: With an audacious flourish, home hero Ian Bell ends all debate

With an audacious flourish, the home hero ends all debate

Ian Bell advances to Trent Bridge next week almost as undroppable as Alastair Cook and Joe Root, a cornerstone of England's new thinking, says Kevin Garside
Aaron Ramsey interview: Wales midfielder determined to be centre of attention for Arsenal this season

Aaron Ramsey interview

Wales midfielder determined to be centre of attention for Arsenal this season