J Med Ethics. 2013 Sep;39(9):541-2. doi: 10.1136/medethics-2013-101745.
Withholding artificial nutrition and hydration.
This special issue, Withholding artificial nutrition and hydration, comprises several papers, commentaries and responses centred largely around the issues raised by the 2011 decision of the English Court of Protection in W v M.i In that case, the mother of an adult patient applied for the withdrawal of life-sustaining treatment (specifically, artificial nutrition and hydration). In 2003, the patient, M, had contracted viral encephalitis and suffered irreparable brain damage as a result. She fell into a coma, and when she emerged appeared to be in a vegetative state and for 8 years was entirely dependent on life-sustaining care.
Following her mother's application, M was held to lack capacity and hence in accordance with section 4 of the Mental Capacity Act 2005 (MCA), the matter turned on whether it was in her best interests for the treatment to be withdrawn. It was made clear in the 1993 decision of Airedale NHS Trust v Bland that life-sustaining treatment could be withdrawn from a patient in a permanent vegetative state (PVS) if, on balance, it was not in his or her interest to continue treatment.ii The MCA also allows for withdrawal of treatment, although the approach to best interests is slightly different. However, the case of W v M is importantly different from the Blandcase, because M was found not to be in a PVS, but instead was minimally conscious (MC). Much evidence was presented of her capacity to respond to stimuli, seemingly express emotion and occasionally speak.
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