Re D (Adult: Medical Treatment)
| Jurisdiction | England & Wales |
| Judgment Date | 1998 |
| Year | 1998 |
| Date | 1998 |
| Court | Family Division |
Medical treatment – Adult suffering severe head injuries in road traffic accident – Very seriously disabled – Some years later suffering further serious brain damage – Admitted to hospital in vegetative state – Whether patient’s condition could be diagnosed as permanent vegetative state – Whether declaration to withdraw artificial feeding and hydration should be granted.
In 1989 the patient, a woman then aged 22, suffered a serious head injury in a road traffic accident. As a result she was very seriously disabled. After a period in hospital she returned to her parents’ home where she received rehabilitative care. In 1995 she suffered unexplained serious further brain damage. She was admitted to hospital in a vegetative state. Over a year later expert medical opinion was to the effect that she was totally unaware of herself or of her surroundings. Her condition met all but three of the clinical criteria for the diagnosis of permanent vegetative state set out in the guidelines, ‘The Permanent Vegetative State’, produced by the Royal College of Physicians in 1996, since there was nystagmus, she was able to track movements with her eyes, and show a ‘menance response’. Consequently, although all the medical experts agreed that the patient had no degree of awareness whatsoever, they were not able to agree that she was in a permanent vegetative state as defined in the guidelines. In the circumstances, the hospital trust sought from the court a declaration that it would be lawful to withdraw the artificial feeding and hydration that was keeping her body alive.
Held –– Even where the clinical criteria in the guidelines produced by the Royal College of Physicians had not been met, it was still possible for the court to grant a declaration that it would be lawful to withdraw artificial feeding and hydration. That was because, under the present procedure, doctors were advised always to seek a declaration of the court which would examine minutely in a public hearing (unless there were very special circumstances to the contrary) all the facts relating to the individual case and, in any event, would only permit or sanction the taking of so extreme a step where there was no possibility of a meaningful life continuing to exist. In this case, all the medical evidence was to the effect that the patient was, for all practical purposes, in a permanent vegetative state and the declaration sought would be granted.
Case referred to in judgmentAiredale National Health Service Trust v Bland[1994] 1 FCR 485, [1993] AC 789, [1993] 1 All ER 821, [1993] 2 WLR 316, CA and HL.
Orginating summonsBy originating summons the applicant, the hospital trust, applied to the High Court for a declaration that it would be lawful for the hospital trust to withdraw artificial feeding and hydration from the adult, Miss MD. The hearing took place and judgment was given in chambers. The case is reported with leave of Sir Stephen Brown P. The facts are set out in the judgment.
Huw Lloyd (instructed by Hill Dickinson, Liverpool) for the hospital trust.
James Munby QC (instructed by the Official Solicitor) for the Official Solicitor.
SIR STEPHEN BROWN P.Miss ‘MD’ was born on 31 October 1967 and is now 29 years old. She was born with a defect which did not persist and which has played no part in her life after her immediate infancy. She grew up to be a fit and healthy young woman. She had a splendid childhood, looked after by her mother and family and, as a young woman, she was active in all forms of sport (skiing, swimming, tennis and everything else) and was studying to become a teacher. On 31 May 1989 she suffered serious injury in a road traffic accident. It was a serious head injury. She was taken to a regional neurosurgical unit and then to hospital where she made progress during her hospital care. She was then returned to her parents’ home for further rehabilitative care. Her mother and family supported and cared for her, employing a full-time rehabilitation carer. The devotion of her mother is remarkable. It was and has been sustained throughout the succeeding years, despite the clear difficulties which it must have entailed imposing both emotional and physical demands on her. Under her mother’s care, she was able eventually to communicate and, indeed, to attend certain art and flower classes and to go on holidays and outings with the family, although she was very seriously disabled indeed. She could not remember what had taken place the previous day and throughout this period she became depressed and expressed serious dissatisfaction with her quality of life and her future prospects. Indeed, intelligently (but sadly) she began to speak of her own death and funeral and invited people whom she met to attend it in due course. On an occasion not long before she suffered a further medical reverse of a very grave nature, she prepared a card at a flower class for her mother, writing in it – I will not read it all out; it has been produced and it is an exhibit:
‘Thank you once again for everything. I do say the biggest Thank You I ever have said before, so please let me go. From [M], with a Hug of Love.’
In September 1995 there was a luncheon at the family house at which a lady who was called ‘aunt’ was present and of whom she was very fond. She spoke
of a wish to be buried in the grave of that lady’s husband to whom she had been attached.
These were clear indications of her outlook at that time. It is right that they should be recalled in the light of what has taken place since.
During the night of 19 September 1995 something happened to her which has never been satisfactorily explained. It is described in medical terms as an ‘insult to the brain’, which caused very serious further brain damage to this already seriously disabled lady. She could not be roused on the morning of 20 September 1995 and was sent again to the neurological centre and there, of course, was examined and treated.
In March 1996 at the request of her mother, Professor Jennet, who is one of the most distinguished leading consultant neuro-surgeons, saw her. He concluded at that stage (28 March 1996) that she was in what he described as a ‘vegetative state with remote prospect of recovery’. It was too early, in the light of the British Medical Association’s advice, to form final conclusions and to make a final diagnosis at that stage. However, his report has been made available to this court and it is perfectly clear that this distinguished and experienced neuro-surgeon considered that she was in an irreversible vegetative state, having no clear or obvious awareness of herself or her surroundings.
She was also seen by Professor Chadwick, a professor of neurology and an honorary consultant neurologist at the centre where she was under treatment. He reported on her and saw her again in January 1997. In his opinion, expressed in his report of 18 January 1997, he said:
‘[M]’s case is unique. We...
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