Bland was injured in the Hillsborough Field soccer crisis when he was 17 1/2 years old, and has been in a persistent vegetative state ever since, with no signs of ever leaving that state. He can breathe by himself, but requires a feeding tube and numerous antibiotics, as well as full care to ensure that he remains in relative good health. His parents have decided that he would not want this, and have asked the doctors to remove the feeding tube to put an end to his life. The lower courts allowed the removal of the tube which his guardian appealed.
- Can life support ever be withdrawn from a patient who cannot give informed consent about the matter?
The Lords struggle with the ethical issues related to this decision. They state that there is no question that Bland is still alive and that in general the sanctity of human life must give way to the principle of self-determination. The doctors also generally have a duty to act in the best interests of their patients. However, they state that there is not an absolute and unqualified duty for doctors to prolong patient's lives, particularly where the necessary procedures to do so are quite invasive and dangerous. Further, an important distinction must be drawn between cases where doctors simply omit from continuing life-prolonging procedures, and cases where they actively assist in death (euthanasia).
The most important factor is that the doctor has a duty to treat the patient in a way that is in the best interests of the patient thus the question is whether it is in Bland's best interests to have his life prolonged by this type of care. Lord Goff states that you must differentiate between cases where the prolonging is not in the patient's best interests because of the nature of the procedures and cases such as this where it is not in the best interests because there is no prospect of any improvement in his condition. In cases such as this one, the treatment is effectively useless because the condition will never improve. Lord Goff says that treatment cannot be said to be appropriate when it is futile as there is no prospect of an improvement in the patient's condition. Therefore, because the treatment is not in the best interests of the patient, the doctors have no duty to administer the treatment. He then discusses whether this is really the same as an "act" leading to death, and determines that it is not. While this would result in a slow death from starvation he states that artificial feeding is a medical treatment, similar to an iron lung, and the decision to use or discontinue use is solely related to what is in the best interests of the patient.
Lord Mustill, in a concurring judgment, says much the same but focuses on the fact that the cessation of the treatment is ethically justified because there was never a duty upon the doctors to administer the treatment, thus there will be no criminal liability flowing from the discontinuation of the feeding mechanism.
- Treatment that is necessary to sustain life can be withdrawn from a patient who cannot give informed consent if withdrawal is seen as being in the best interests of the patient.
- You only turn to this test if the patient cannot express their own wishes, or has not left something expressly stating their wishes.
- Doctors are never under a duty to administer treatment to keep someone alive at all costs if the required treatment is very invasive.