Re H (Adult: Medical Treatment)
| Jurisdiction | England & Wales |
| Judgment Date | 1998 |
| Date | 1998 |
| Court | Family Division |
Medical treatment – Permanent vegetative state – Adult suffering severe brain damage in road traffic accident – Evidence of visual tracking – Patient not fully within Royal College of Physicians’ guidelines for diagnosis of permanent vegetative state – Application for declarations to discontinue life-sustaining treatment – Whether declarations would be granted.
In 1994 the patient, a woman now aged 43, suffered very serious brain damage in a road accident. She was admitted to hospital immediately but her condition was such that three days after the accident all sedation was stopped. Over a period of three years there was an extremely detailed investigation into the patient’s condition and it was found that she had no prospect of recovery. She did not meet all 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, in that there was evidence of ‘visual tracking’. However, she did fit within the criteria published by an international working party in a report on the vegetative state prepared in 1996 for the Royal Hospital for Neuro-Disability at Putney and all the experts were agreed that it would be correct to describe her as being in a vegetative state and that the condition was permanent. The National Health Service trust, supported by the Official Solicitor, sought declarations that it would be lawful to cease all life-sustaining and medical support procedures.
Held — Although the patient did not fit four square within one guideline of the criteria laid down by the Royal College of Physicians, what the witnesses had described was an insentient patient completely dependent on artificial feeding by tube, on a tracheostomy for breathing, and on round the clock nursing for all physical needs. She was unable to communicate or to acknowlege anything that was taking place. The patient had the most careful assessment over the last three years and there was no possibility of any improvement in her situation. The court was aware of the serious consequences which would follow the suspension of treatment, but it did not in any sense sanction anything which was aimed at terminating life. On the facts, it was in the interests of the patient that the life-sustaining treatment presently being artifically administered be discontinued, and therefore the declarations sought would be made.
Cases 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.
D (adult: medical treatment), Re[1998] 1 FCR 498.
J (a minor) (wardship: medical treatment), Re [1991] FCR 370, [1991] Fam 33, [1990] 3 All ER 930, [1991] 2 WLR 140, CA.
Originating summonsBy originating summons the applicant, a National Health Service trust, applied to the High Court for declarations that it would be lawful for the hospital to withdraw all life-sustaining and medical support measures from the adult, Mrs H, designed to maintain her life in a permanent vegetative state. The facts are set out in the judgment.
Robert Francis QC and Adrian Hopkins (instructed by Cole & Cole, Oxford) for the plaintiff.
Caroline Thomas (instructed by the Official Solicitor) as amicus curiae.
SIR STEPHEN BROWN P.This is an application by a National Health Service trust for declarations that it is in the best interests of a patient known as Mrs H to discontinue all life-sustaining treatment and medical support measures designed to keep her alive in her existing persistent vegetative state. The said treatment and measures include the administration of nutrition and hydration by artificial means. Further declarations are sought which support the principal declaration.
This is another of the very sad cases of a patient who has suffered very serious brain damage and who is, unhappily, in hospital in a state which may well fall within the description of a ‘living death’. The patient concerned is a lady who suffered very serious brain damage in a road accident in May 1994. She is now 43, she has two children and a husband to whom she has been married for 20 years. She also has parents who are still alive...
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Practice Note (Official Solicitor: Declaratory Proceedings)
...Practice note – Official Solicitor – Declaratory proceedings – Medical and welfare decisions for adults who lack capacity ... [1] This practice note supersedes Practice ... This practice note deals only with adults who lack capacity. Medical treatment or welfare disputes about children will be dealt with under the Children Act 1989 or the inherent ... [2] The High Court has jurisdiction to make declarations as to the best interests of an adult who lacks decision-making capacity. The jurisdiction will be exercised when there is a serious ... ...