Health check: Life, death and the law

Death, as the saying goes, is one of only two certainties in life. But the ethics of how we choose to exit this mortal coil - and the question of whether we should have a choice at all - are becoming increasingly problematic.

Death, as the saying goes, is one of only two certainties in life. But the ethics of how we choose to exit this mortal coil - and the question of whether we should have a choice at all - are becoming increasingly problematic.

Recently the High Court ruled in favour of a terminally ill man who wanted to ensure that doctors continue to treat him even when he is too sick to make his wishes clear. Leslie Burke, 44, has a degenerative neurological disease called cerebral ataxia, which affects muscle movement and is ultimately fatal.

Mr Burke is already in a wheelchair and knows what is in store. His biggest fear is that by the time he becomes too weak to feed himself and cannot make decisions, his doctors could rule that he no longer has sufficient quality of life and thus withdraw his artificial nutrition and hydration (ANH).

Mr Burke brought the case because he was concerned that current General Medical Council (GMC) guidelines left him at risk of having life-prolonging treatment withdrawn without his consent. Backed by the right-to-life lobby and several disability charities, he asked the High Court to rule that the current GMC guidance contravened the Human Rights Act.

Disability campaigners want the emphasis on "quality of life" to be removed from GMC policy, arguing that it relies too much on doctors' opinions rather than an individual's assessment of their condition.

At first reading, the High Court ruling by Mr Justice Mumby was an apparent victory for Mr Burke - the judge upheld his claim and ordered the GMC to re-draft its guidelines.

But on reflection it is a rather pyrrhic victory for the right-to-life lobby. While saying that Leslie Burke is entitled to treatment, it also grants patients the right to refuse it. The ruling states: "Important as the sanctity of life is, it has to take second place to personal autonomy. In the final analysis it is for the patient, if competent, to determine what is in his own best interests. Medical opinion, however eminent, can never be determinative of what is in a patient's best interests."

The GMC intends to appeal, saying that the current guidelines already protect a patient's right to life, and that in cases where there is a dispute, the accepted policy is to ask the courts to rule anyway.

Next month a House of Lords select committee will begin an historic investigation into the current law on assisted suicide. The last such investigation was in 1993 and recommended that legislation should not change. Euthanasia campaigners are hoping that the forthcoming investigation will back a change in the law, a decision that would put pressure on the Government to launch a public consultation. The hearings should be gripping, and it already appears that both the public and the medical profession think differently than they did ten years ago. Officials at the Royal College of Nursing (RCN), which has been asked to submit evidence to the inquiry, say a "sizeable minority" of their members are in favour of a law on assisted suicide. The RCN, which has always been opposed to euthanasia, is now considering changing its stance.

In 1992, judges ruled that it was legal for doctors to withdraw ANL from Tony Bland, a victim of the Hillsborough football disaster who had been in a persistent vegetative state for three years. Nearly ten years later, the High Court refused a plea by motor neurone disease sufferer Diane Pretty to be allowed the right to assisted suicide. The Leslie Burke ruling and the House of Lords investigation could be the catalyst for a historic change in the law - one that would protect the right to death, as well as the right to life.