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Court Proceedings Are Not Necessary For Withdrawing Life Support –UK Court Of Protection [Read Judgment]

The UK Court of Protection has clarified that decisions to withdraw life support treatment to patients in Permanent Vegetative State(PVS) or Minimally Conscious State(MCS) need not always be taken with judicial approval. It was held that if the decision was taken on agreement between doctors and family members in accordance with the professional guidelines, Court intervention was not a mandatory requirement. The UK Court of Protection has clarified that decisions to withdraw life support treatment to patients in Permanent Vegetative State(PVS) or Minimally Conscious State(MCS) need not always be taken with judicial approval. It was held that if the decision was taken on agreement between doctors and family members in accordance with the professional guidelines, Court intervention was not a mandatory requirement.

The Court of Protection in United Kingdom is created under the Mental Capacity Act 2005 to determine issues pertaining to welfare and best interests of persons under mental incapacity. The Court was dealing with the case of a  lady who was suffering from a rare neurological disorder called Huntington’s disease, which rendered her in a ‘Minimally Conscious State’. The Court proceedings were initiated for permission to withdraw the Clinically Assisted Nutrition and Hydration(CANH) given to the patient on the ground that it was not in her best interests to continue the treatment.

After considering the testimonies of her mother, other family members and doctors, Justice Peter Jackson of the Court of Protection reached the conclusion that it was not in the patient’s best interest to continue the CANH, and permission was accorded to withdraw the same. The Court stated that a decision on such a matter should be guided by the following considerations under the Mental Capacity Act :-

  • Where a person is unable to make a decision for herself, there is an obligation to act  in her best interests:
  •  Where a decision relates to life-sustaining treatment, the person making the decision  must not be motivated by a desire to bring about death:
  •  When determining what is in a person’s best interests, consideration must be given to all relevant circumstances, to the person’s past and present wishes and feelings, to the beliefs and values that would be likely to influence her decision if she had capacity, and to the other factors that she would be likely to consider if she were able to do so:
  • Account must be taken of the views of anyone engaged in caring for the person or interested in her welfare:

Incidentally the Court also considered the topical issue as to the necessity of obtaining court sanction for taking a decision to withdraw life support. For declaring that Court proceeding was not necessary, the following reasons were given :-

  • There was no such statutory obligation to approach Court. It was a matter of practice as opposed to matter of law
  •  Treatment decisions up to and including the withholding and withdrawal of life-support are taken by clinicians and families working together in accordance with recognised good practice. All such decision cannot be subject of external supervision.
  •  The decisions involving withdrawal of life supporting system are not so different from other serious medical treatment decisions to justify a different approach.
  • Cost and time of litigation process is a deterrent to the best interests of the patient. The Court cited the case at hand as an example where the patient had to be in life support for one year awaiting judicial decisions, despite the fact that family and doctors firmly held that continuation of treatment was not in her best interest.
  • The grave consequence and risk of error in an advance decision on agreement by family and doctors, and the decision rendered by the court are not so different.

Read the Judgment Here

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