LIFE BITE: Court’s permission not required in agreed end-of-life decisions

apple-150579_1280The Supreme Court has now ruled that there is no requirement for families or doctors of patients in a permanent vegetative state to seek permission from the Courts prior to withdrawing medical treatment.


The case was brought before the Court after a man in his fifties, known as Mr Y, suffered a heart attack in June 2017 which resulted in extensive brain damage. Mr Y never regained consciousness and thereafter required assisted nutrition and hydration to keep him alive. His doctor concluded that if Mr Y ever did regain consciousness, he would be severely disabled and would be dependent on care from others for the rest of his life, an opinion was supported by other medical professionals. 

Mr Y’s wife and children were of the view that he would not wish to be kept alive given this prognosis.  The family and doctors agreed that agreed that it would be in Mr Y’s best interests for treatment to be withdrawn, which would result in his death within several weeks.

In November 2017, upon application by the NHS to the Court, the High Court granted a declaration confirming that it was not necessary to seek the Court’s approval for withdrawal of treatment from Mr Y when his medical team and family agreed that continued treatment was not in his best interests.

The Official Solicitor argued that human rights law required every case involving the withdrawal of medical treatment be the subject to a ‘best interests’ application, regardless of whether the medical professionals and families agree. Given the circumstances in this case, the Judge granted the Official Solicitor permission to appeal directly to the Supreme Court.

The question for the Supreme Court was, when dealing with patients with a prolonged disorder of consciousness such a Mr Y, whether a Court Order must always be obtained before life prolonging treatment can be withdrawn or whether, in some circumstances, treatment can be withdrawn without the Court’s involvement.

Mr Y sadly died prior to the matter being adjudicated upon though the Supreme Court determined that the appeal should go ahead due to the general importance of issues raised by his case.

The Supreme Court unanimously ruled that neither UK common law or the European Convention on Human Rights (ECHR) gave rise to an obligation to involve the Court to decide upon the best interests of every patient in cases such as Mr Y’s.

In the judgment, Lady Black indicated that; “If at the end of a medical process, it is apparent that the way forward is finely balanced, or there is a difference of medical opinion, or a lack of agreement to a proposed course of action from those with an interest in the patient’s welfare, a Court application can and should be made”.

Safeguarding your wishes on end of life treatment.

Cases of this nature can create a moral divide –those who believe in the sanctity of life may find the notion of withdrawing treatment in this manner deeply offensive.  However, for others, the idea of being compelled to endure an existence with virtually no quality of life can seem intolerable.

The law requires medics to take into account a patient’s express wishes when considering their medical care.  As such, a person can execute a ‘Living Will’ (also known as an ‘Advance Directive’) setting out the type(s) of medical treatment they would not want should they become gravely ill in the future and be unable to make or communicate decisions at that time.

A Living Will cannot insist upon medical treatment being given but it can specify if and when medical treatment should be withheld to allow death to occur.  This can include expressing a wish not to be resuscitated in certain specified and limited circumstances.

What are the benefits of making a Living Will?

There are several benefits to making a Living Will:

  • It can help you feel more in control of your circumstances and future care.
  • It can help you avoid painful or difficult treatments that may not always be helpful anyway.
  • It means your family will know what you want and can respect your wishes.
  • It can help avoid disagreements about your care and treatment within your family or health and social care team.

A Living Will should not be entered into lightly and should be discussed with both a medical practitioner and experienced lawyer to be fully aware of the implications, and also the practicalities of where this document may be held to ensure that it is available to medical practitioners should circumstances set out in the Living Will come to pass.

For further information on this area, please feel free to contact us here or post your comments below.