A brain-damaged, minimally conscious woman known to the courts as "M" has been denied the "right to die" by a High Court judge, in what has come to be seen as a landmark case.
An English court had never been asked to decide whether life-supporting treatment should be removed from a patient in a "minimally conscious" rather than "persistent vegetative" state. The UK has hundreds of people in a "minimally conscious" state.
Mr Justice Baker acknowledged that before her illness, "M" had told her family she would not want to be kept alive in such circumstances, but said such statements were "informal" and not legally binding. "The factor which does carry substantial weight, in my judgment, is the preservation of life," he said. "I find that she does have some positive experiences and, importantly, that there is a reasonable prospect that those experiences can be extended by a planned programme of increased stimulation."
Lawyer Yogi Amin, a partner with law firm Irwin Mitchell, which represented M's family, added: "The family learned of the judge's decision yesterday and were deeply disappointed."
He went on: "There can be no question that the past eight years have been extremely heartbreaking for them all. They love her dearly and want only what is best for her, and it has been desperately difficult for them to make this application to court for treatment to be withdrawn.
"They believe that M was clear that she would not have wanted to live in the condition that she is in."
In February 2003, M, then 43, was supposed to be departing for a skiing holiday but was found by her partner in what Mr Justice Baker's ruling describes as "a drowsy and confused condition". At hospital she fell into a coma and it was discovered she had suffered viral encephalitis, leaving her with extensive and irreparable brain damage. Initially doctors said she was in a persistent vegetative state, until subsequently discovering she was partially capable of response to stimulus and conscious of her environment.
M lives in a care home in the north of England. Her family say her daily life consists of being removed from bed, showered, sat in a chair and then returned to bed. She was not at court yesterday, neither were her family, who also cannot be named.
M's family and their lawyers will now consider the ruling and see if there is a route to appeal. Mr Amin added: "This is a very important judgment. The law has been clarified and, going forward, in all such cases of patients who are in a minimally conscious state, the High Court does now have the power to decide on whether it is in that patient's best interests for treatment to continue, or whether the patient should be allowed to die naturally, with dignity."
He also again urged, as M's family has done before, the importance of creating a "living will" – a clear legally binding statement of what an individual would like to happen to them should they end up in such a condition.
Mr Justice Baker, who has visited M in her care home, praised M's family and carers for their devotion. He said they should now work together with her doctors and carers on a revised care plan. In July, the court was told M may expect to live for another 10 years.
What is minimal consciousness?
When a patient emerges from a coma, it is often all but impossible for doctors to tell if he or she is in a "minimally conscious" or "persistent vegetative" state.
Some show signs of consciousness now and again, but find it difficult to communicate. Tests include answering "yes" or "no", either verbally or with gestures.
The condition is distinct, though similar in appearance to the "locked in syndrome", in which a patient is completely conscious, but incapable of movement.
In 2007, doctors claimed to have restored full consciousness to an American "minimally conscious" man, after putting electrodes deep in his brain.
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