By Ann Marie Foley - 01 August, 2018
Permission is no longer needed to end care for patients in a permanent vegetative state, a UK court has ruled.
On 30 July 2018, the United Kingdom Supreme Court ruled it is no longer necessary to seek legal permission from the Court of Protection to remove artificial feeding and hydration from patients in a persistent vegetative state.
Catholic Bishop John Wilson responded to the UK court ruling stating: “This means that clinicians and families can decide among themselves to bring about a patient’s death by discontinuing the provision of food and water by artificial means.”
In outlining where the new ruling applies the Bishop explained that a person in a persistent vegetative state can exist in an altered state of consciousness following some kind of trauma. The person breathes without assistance and follows patterns of sleeping and waking, although without any detectable external response. They are not dying as such but remain dependent on medical and nursing care.
The Catholic Bishops’ Conference of England and Wales addressed the question of artificial feeding and hydration in cases of patients in a persistent vegetative state in their 2004 teaching document Cherishing Life which addresses the ethics of suicide and euthanasia.
In it the Bishops stated: “There is a basic level of nursing care that is demanded by human solidarity. We all recognise that leaving a patient cold, unclean, in pain or without human contact for significant periods of time would fall below a decent standard of care. Within the health service, great efforts are made to maintain high standards in this area, despite the pressure of resources and limited staff. In general, providing food and fluids should also be considered basic care.”
“When patients are in the final phase of dying they should not be troubled by intrusive treatment, and efforts to place or replace a feeding tube may well be excessive or burdensome,” the Bishops’ statement continued.
“[However], what is not morally acceptable is to withdraw tube-feeding, or other life sustaining treatment, precisely in order to end a patient’s life. This would cross the line from reasonable withdrawal of inappropriate treatment into the realm of passive euthanasia.”
No one should underestimate the challenges placed on families and carers when a loved one enters a persistent vegetative state, Bishop Wilson said, adding that sustained pastoral support for them is essential. However, he also emphasised that patients in persistent vegetative states are “some of the most vulnerable” in society.
“It is not an act of compassion to remove their food and drink in order to cause their death. Equally, it cannot be in a patient’s best interests, whatever their level of consciousness, to have their life intentionally ended. Our care for those in such situations is the test of our common humanity and our solidarity with some of the most fragile of our brothers and sisters,” he concluded.
The Anscombe Bioethics Centre in the UK expressed concern about the court ruling. “The recent Supreme Court judgement, An NHS Trust and others v Y, in effect makes it much easier for doctors to deprive patients with prolonged disorders of consciousness of the food and water they need to live.”
The Centre highlighted that Pope John Paul II was very clear that the provision of nutrition and hydration is, in principle, obligatory, even when this is clinically assisted. While clinically assisted nutrition and hydration remain effective and where the means do not impose a great burden on the patient (which they do not for an unconscious patient, in particular), then it is unethical to remove them.