The persistent vegetative state: legal and ethical issues

Abstract

Recent advances in technology and medical expertise have enabled doctors to prolong the lives of many severely injured patients who only a few years ago would have died from their injuries. The prolongation of life by such measures has raised many legal, ethical and social issues. When in 1992 the House of Lords determined in Airdale NHS Trust V Bland that life-supporting measures, including artificial nutrition and hydration (ANH) might lawfully be withdrawn from Anthony Bland, a patient in a persistent vegetative state (PVS), attention was focused on these issues particularly as they apply to the patient in PVS. Since the PVS patient is neither competent to refuse treatment, nor is he dying or suffering, the reasons normally advanced for withdrawing life-supporting measures do not apply. In Bland, their Lordships relied on the best interests test laid down in Re F (mental patient: sterilisation) [1989] 2 All ER 545, and, with the exception of Lord Mustill, on the Bolam test (Bolam v Friern Barnet Hospital Management Committee) [1957] 1 WLR 582. This thesis examines the decision mBland and addresses some of the issues raised. The appropriateness of the best interests test as applied to the patient in PVS is explored and compared with the approach of substituted judgement employed in some other common law jurisdictions. The relevance of the Bolam test to decisions regarding the withdrawal of life-supporting measures is considered. The legal requirements for the withdrawal of ANH are discussed, together with the ethical debate and the moral dilemmas posed by its withdrawal. Finally, the question as to whether the decision in Bland is good law is addressed, and it will be argued that whilst it may be morally acceptable to withdraw ANH from some patients, as regards a patient in PVS, the moral imperative is that we should not.