Joint Committee on the Draft Mental Incapacity Bill Written Evidence


96.Memorandum from Alison Davis (MIB 337)

SUMMARY

  This is a personal submission. I have several severe disabilities and 18 years ago I wanted to die, a settled wish that lasted over 10 years. Had the legally binding Advance Decisions described in the MIB been in place then, I would not now be alive. I have Power of Attorney for my elderly mother who has senile dementia.

  The submission highlights grave dangers in the draft Mental Incapacity Bill (MIB).

  Section 2 highlights dangers associated with the MIB's definition of "best interests" as being the ascertainable past and present "wishes and feelings" of the incapacitated person. I suggest that this is highly dangerous and that the incapacitated person's clinical best interests should be the criteria which determine their treatment. Several examples are given of cases in which an apparently incapacitated person was assumed to be "better off dead."

  Section 3 notes the dangers of assuming that Advance Decisions are legally binding. It also questions the received wisdom that assisted food and fluids are "medical treatment" which can legitimately be withheld or withdrawn. This section notes that many people make decisions when they are ill which are not consistent with their Advance Decision. Several examples are given which highlight the dangers of such Decisions being legally binding.

  Section 4 mentions the problems of allowing Lasting Powers of Attorney to make life and death decisions on behalf of incapacitated people. It notes that a change is needed to ensure that anyone who acts on behalf of an incapacitated person with the purpose, or a purpose, of hastening their death should be guilty of a criminal offence.

  Section 5 highlights the contradiction in terms of naming as the "Court of Protection" a body one of whose chief functions should be to underwrite decisions to withhold or withdraw food and fluids with the aim of causing or hastening the death of an incapacitated person.

  Section 6 notes that the Government has claimed to be "opposed to euthanasia" but shows that in supporting the MIB, it is also supporting the killing by neglect of the most vulnerable people, notwithstanding its own very narrow definition of "euthanasia".

  Section 7 highlights some of the unsatisfactory terminology used in the MIB, for example the claim that food and fluids delivered by tube or PEG are "artificial," rather than assisted, nutrition and hydration.

  Section 8 explains why I would not now be alive had the terms of the MIB been in place 18 years ago.

  Section 9 is a brief appeal to the Government to act to protect the true, clinical, best interests of the most vulnerable people. If it fails to do so, it will be guilty of killing in the name of "protection"—a contradiction in terms and the most serious derogation of its duty to care for those who cannot speak for themselves.

1.  INTRODUCTION

  I write as a member of the public who has a particular interest in the issue of decision making for people with mental incapacity. I have spina bifida, emphysema and osteoporosis and am a full-time wheelchair user. I have particular concerns about legally binding "Advance Decisions" since, had these been available 18 years ago, I would not now be writing these comments (see section 8.1).

  My mother has senile dementia and does not have the mental capacity to make medical decisions for herself. I have Power of Attorney for her.

  I have read the Draft Mental Incapacity Bill (MIB), and have grave concerns about some of its contents.

2.  "BEST INTERESTS" AND AUTONOMY

  2.1  "Best interests" are generally understood, as is reflected in case law[11], to include basic factors such as preserving life, maintaining or restoring health and minimising suffering. It is extremely worrying that the Draft Bill makes no mention of clinical "best interests" nor of the patient's interest in not being deliberately killed, for example by having food and fluids withdrawn. Rather in the draft MIB "best interests" is defined as the ascertainable past and present "wishes and feelings" of the incapacitated person.

  2.2  This is problematic for many reasons, not least in the case of depressed people who are suicidal. They "wish" to die and "feel" that death is in their best interests, but any doctor worthy of his or her profession would nevertheless overrule these wishes and feelings and institute treatment to save and/or sustain the life of such a patient. Similarly even if a patient strongly "feels" that a particular drug would benefit him and "wishes" it to be prescribed, a doctor should prescribe it only if he feels it will actually benefit the patient's medical condition. Relying on "wishes and feelings" suggests that life is not a basic good unless the individual recognises it as such.

  2.3  It is unclear how the "best interests" of people in Persistent Non-Responsive State (generally known as Persistent Vegetative State or PVS) would be served, if "wishes and feelings" are the only criteria for deciding who should die. Tony Bland, who was killed by withdrawal of his food and fluids in 1993 had never made his "wishes and feelings" clear on what he would want were he to become incapacitated. He was killed because other people "felt" that death was in his best interests and "wished" him to die.

  2.4  Lord Mustill, a member of the appellate committee of the House of Lords which decided the Tony Bland case and a member of the 1993-94 House of Lords Select Committee on Medical Ethics proposed the highly objectionable view that Tony Bland had no best interests because he was profoundly disabled.[12]. If a person has "no best interests" there would seem to be no justification for not killing him.

  2.5   There have been many cases of people being wrongly diagnosed as being in PVS for whom withholding or withdrawing food and fluids has been considered in their "best interests." One such case was that of Marian Sallery.

  Marian Sallery was paralysed after a stroke in 1983 when she was 36 years old. Doctors told her parents that she was in PVS and would always be "a cabbage." They discussed withdrawing Marian's food and fluids in her presence. Her parents refused. Marian was transferred to the Royal Hospital for Neurodisability in Putney in 1990, and subsequently to a Leonard Cheshire Home, where she lived happily until her early death in 1994.

  A post-mortem revealed that Marian had never been in PVS. Instead she had Locked-In syndrome, a condition in which the person cannot move or communicate but remains fully conscious and aware. Marian's mother said the doctors "stood by her hospital bed and told us we should live our lives and accept that she was dead. She would have heard everything."[13]

  It is interesting to note that the doctors stated that Marian was "already dead" before the planned withdrawal of food and fluids, suggesting that living with disability is a form of "living death." Disabled people need protection from the harm of being assumed to be "as good as dead."

  Similarly Catherine Roberts, who is now 31 years old, had her food withdrawn after she had been in a coma for more than two months in 1992. She was expected to die within 48 hours, but eight weeks later she was still alive. Doctors decided to remove her tracheostomy tube, but the day before they planned to do this, Catherine responded to her mother's voice by blinking, sticking out her tongue and mouthing "I love you."

  Six years later Catherine Roberts uses a wheelchair and is responding well. She accepted a £100,000 out of court settlement from the Royal Bournemouth and Christchurch Hospital Trust after issuing a writ alleging negligence in failing to make a proper diagnosis and provide appropriate care[14]

  Had the terms of the draft MIB been in place earlier, both Marian Sallery and Catherine Roberts would probably have been assumed to have "no best interests" like Tony Bland. Their cases show the appalling consequences of assuming that it is in the "best interests" of any patient to be starved to death.

  2.6  In such situations the draft MIB suggests that Advance Statements should be used or, if no such statement has been made, that carers should be consulted about the patient's "past and present wishes and feelings and the factors he would consider if he were able to do so." There is no objection to carers and relatives commenting on how best to ascertain the clinical interests of a patient, but it is highly dangerous to put such people in the position of making judgements based on subjective assessments of what the patient "would have wanted" which may more accurately reflect their own interests.

  2.7  None of the foregoing should be taken as implying that doctors should be required to provide straightforwardly futile or disproportionately burdensome treatment or to prolong life at all costs. It is clear that if a patient is irremediably dying s/he needs palliative care rather than treatment aimed at cure. Indeed, it is part of truly acting in the patient's best interests that the probable burdens of treatment options are addressed and inappropriate treatments either not initiated or withdrawn. Nevertheless, it is never right that a doctor's actions have the purpose, or a purpose, of causing or hastening the death of a patient. Being deliberately killed is never in a patient's "best interests."

3.  THE ROLE OF ADVANCE DECISIONS IN DECISION MAKING

  3.1  The Government has repeatedly stated that it will not make Advance Decisions legally binding, following the recommendation of the House of Lords Select Committee that Advance Decisions not be given greater legal force because this would risk "depriving patients of the benefit of the doctor's professional expertise and of new treatments and procedures which may have become available since the Advance Decision was signed."[15]

  3.2  However, the MIB suggests that Advance Decisions are legally binding. This follows on from the leaflets produced by the Lord Chancellor's Department as part of the Consultation Paper Making Decisions: Helping People who have Difficulty Deciding for Themselves, which state that:

    "So long as the advance statement is clear and is applicable in the particular circumstances in which treatment is proposed, health care professionals are bound by your earlier decision, even if they or your relatives or carers disagree with it (Re T (Adult: Refusal of Treatment) [1992] WLR 782)"[16]

  3.3  The truth is that it has not actually been satisfactorily established that Advance Decisions are legally binding. The suggestion that they are binding appears to rest on three cases which are regularly cited in this regard. I assert that this claimed "proof" that such Decisions are legally binding is faulty for the following reasons:

    (a)  Airedale NHS Trust v Anthony Bland. Anthony Bland was in a Persistent Non-Responsive State and died of starvation and dehydration after successive Court rulings approved his doctor's wish to withdraw his nutrition and hydration. The Court admitted that he had at no time given "any indication of his wishes" and by the time the decision was made, was completely unable to do so[17]

    (b)  Re T. This case was of a Jehovah's Witness who refused a blood transfusion. The aim of the refusal was not deliberately to end the patient's life, but was made because of religious beliefs concerning blood transfusions. The refusal of a transfusion did not involve a general refusal of treatment made in advance of the time when the patient was subject to the relevant condition[18]

    (c)  Re C. In this case the Court decided that the patient, who had schizophrenia, was nevertheless competent to refuse amputation of his leg, which was gangrenous. This Court ruling was binding on the doctors concerned, but the patient could have changed his mind at any time, and he knew the consequences of refusing the amputation. Again, this decision was not made in order deliberately to hasten death and, like Re T, this was not a case of a general refusal of treatment made in advance of the time when the patient was subject to the actual condition for which he refused treatment[19]

  3.4  These cases serve to illustrate that doctors are not, in fact, forced to act upon an Advance Decision. Additionally Mr Justice Hughes, in a ruling in 2001, indicated several provisos which must be present before Advance Decisions should be taken as legally binding, suggesting that if any one of them were not in place, the Decision would not be binding.[20] It is extremely worrying that the draft MIB would radically change this situation. Under its terms, any validly made out Advance Decision would be a binding legal instrument regardless of how old it was, how ill-informed the person making it, how hypothetical the condition or how much it anticipated the facts.

  3.5  Since the Bland and Law Hospital judgements[21][22]food and fluids delivered by tube or PEG (Percutaneous Endoscopic Gastrostomy) have been considered "medical treatment" which can be withdrawn. Thus a doctor can withdraw or withhold them citing "medical grounds." The draft MIB would allow "Advance Refusals" of "treatment" including food and fluids. I suggest that food and fluids, however delivered, are not "medical treatment" but basic nursing care, which should be provided unless the individual is close to death, and food and fluids would be unduly burdensome to him or her.

  3.6  Doctors should strive to act in the clinical best interests of their patients. Doctors regularly resuscitate suicidal patients, even if there is a clearly written suicide note showing that the patient intended their actions to cause death. Similar judgments need to be made in the case of Advance Decisions with a clear suicidal intent in the event of the person becoming mentally incapacitated.

  3.7  In the case of a patient who cannot make a current decision, the same duty of acting in his or her clinical best interests holds for the doctor. Deliberately causing or hastening the patient's death should never be part of ethical medicine.



  3.8  One problem in taking into account an Advance Decision refusing life saving or life-prolonging treatment is that by the time the decision is being taken by others, the person will almost certainly be incapable of indicating any change of mind. What one thinks one would want in a completely hypothetical situation, never before experienced, is not necessarily what one will want if that situation actually arises. This is particularly true of disabling conditions. Able bodied people, including some doctors, frequently have a very negative attitude towards living with disability, but once they actually experience it, their attitude is likely to become much more positive.[23]

  3.9  It has been shown that people often make decisions when they are ill that are not consistent with their Advance Decision. It has been found that

    Approximately 1/3 of patients changed their preferences in the face of actual illness, usually in favour of treatments rejected in advance.[24]

  The same study found that proxy decisions did not always agree with previously stated preferences. However, they erred in the same direction as those of ill and disabled people—towards treatment rather than against it. Treating Advance Decisions as legally binding means that there is no possibility of a change of mind, because the person would have been pushed into a death they might well no longer want.

  3.10  Under the draft MIB, revocation of the Advance Decision requires "capacity" otherwise the Decision is valid and binding (note the case of Mrs Majorie Nighbert in section 4.2 and 4.3) While the draft MIB states that the Decision is not valid if the patient does "anything else clearly inconsistent with the advance decision remaining his fixed decision" this is less than helpful because the inconsistent act will only count if the person has "capacity" (see again the case of Mrs Nighbert). There is a grave problem as to who would give evidence to an "inconsistent act." If it is to be the Lasting Power of Attorney, there is a danger that s/he would have an interest in the incapacitated person's early death.

  3.11  This sort of danger has been highlighted by Baroness Ilora Finlay, a Hospice doctor. She has spoken about a patient of hers, a lady aged 59, who was very ill. Her family seemed to be very concerned about her pain, and constantly asked for her diamorphine to be increased. However, the Hospice staff were not convinced that her pain was really that severe, and the patient herself declined increasing doses of diamorphine.

  The lady's 60th birthday passed with minimal celebration, after which the family visited her very little. She became very depressed, and finally told a night nurse that on her 60th birthday, her fixed-term life insurance policy expired, so the family would not now inherit the amount they had expected had she died. They had wanted her drugs increased, ultimately, so that they could inherit her money[25]

  3.12  The House of Lords Select Committee, which reported in 1994, opposed giving Advance Decisions greater legal force, saying this would risk "depriving patients of the benefit of the doctor's professional expertise and of new treatment and procedures which may have become available since the Advance Decision was signed[26] I suggest that this concern is equally valid today.

  3.13  Allowing people to set out in advance the types of treatment they would, or would not, be prepared to accept assumes a degree of medical knowledge which few lay people possess. Even if one researched the subject and found out all the possible conditions one might experience, and all the possible treatments which might be available (which is in itself hardly a realistic prospect), the fact is that medicine is always advancing. What is extraordinary today may well be commonplace tomorrow, and new treatments become possible almost every day. All these factors would call into question the validity of an Advance Decision.

  3.14  The British Medical Association has said that:

    While the BMA recognises the advantages in terms of encouraging openness, dialogue and forward planning, it is not proselytising on this issue (Advance Decisions). The BMA Code of Practice draws attention to disadvantages as well as benefits of anticipatory decision-making. Health professionals and the public should be aware that treatment decisions are complex, medicine is uncertain, practice is constantly evolving and there is always the possibility of a mistaken diagnosis. Views also change about what constitutes a tolerable existence. Advance Directives cannot encompass unforeseen possibilities and options. Therefore . . . the BMA is not actively encouraging people to undertake the risks associated with committing themselves in advance[27]

  3.15  Unlike Lasting Powers of Attorney, Advance Decisions would not have to be registered under the terms of the draft MIB, allowing for them to be made orally. Thus all that would be needed for such a statement to be binding would be someone to say: "I heard Mrs Smith say she didn't want to be treated if she was in this condition." In such circumstances it would then be illegal for the doctor to give the patient treatment—presumably including tube delivered food and fluids. This would make lethal neglect compulsory, which is clearly unethical.

  3.16  The draft MIB creates punishments for "concealing or destroying" Advance Decisions, including those which refuse "medical treatment" (a term which is taken to include assisted food and fluids.) Thus doctors could be punished for saving a life, a travesty of their traditional role, and of the instruction in the Hippocratic Oath "primum non nocere."

4.  LASTING POWERS OF ATTORNEY

  4.1  I note that the draft MIB allows people to appoint a Lasting Power of Attorney, who would be able to act on welfare matters (including "healthcare") as well as financial matters.

  4.2  While LPA's may have a legitimate role to play in ensuring that incapacitated people receive beneficial healthcare, they can also have huge dangers when they are involved in making decisions about issues concerning life and death. These dangers are highlighted by the case in Florida USA of Mrs Marjorie Nighbert, an 83 year old lady who was in a nursing home after a stroke. She was deprived of a feeding tube by a Court order on 23 March 1995. A nurse heard her ask "Will you give me a little something to eat?"

  4.3  Mrs Nighbert was not given food by mouth on the pretext that there was a danger of her choking. A nurse who gave her some milk was reprimanded. She had never signed an Advance Directive, but had given Power of Attorney to her brother, who forbade tube feeling. A judge decided she was "not mentally competent" to revoke the Power of Attorney giving her brother power to have her starved to death, and she died on 6 April 1995.

  4.4  It might be objected that this situation would not arise under the draft MIB because it allows for revocation by "inconsistent act." But what if the family are the ones who witness such an act and they, for reason of personal gain or any other reason, choose not to convey information about it to those who are not feeding the incapacitated person? (see section 3.11) The MIB needs to include a clause making it clear that if any person named as an LPA sets in motion an action on behalf of the incapacitated person with the purpose, or a purpose, of causing or hastening his or her death, the LPA would be guilty of a criminal offence.

5.  THE COURT OF PROTECTION

  5.1  The Court of Protection is a contradiction in terms because one of its chief functions would be to underwrite decisions to withdraw or withhold food and fluids from vulnerable people, and thus to cause their deaths. It would be impossible for anyone opposed to such medical killing to sit on the Court of Protection since s/he could take no part in its function of supporting decisions that mentally incapacitated people be starved and dehydrated to death.

  5.2  Rosie Winterton, Health Minister, has said:

    The Department of Health welcomes the publication of the draft Mental Incapacity Bill . . . These are proposals to provide increased protection and autonomy for many of our vulnerable client groups, including those with a learning disability, older people with dementia and those with mental health difficulties[28]

  If starving and dehydrating vulnerable people to death is "protection" then what hope is there of any patient being treated according to traditional, clinical "best interests" criteria?

  5.3  It should be noted here that the British Medical Association have argued that cases of withholding or withdrawing food and fluids from people who have advanced dementia, or who have had a severe stroke should not "routinely be subject to Court review."[29] The Court of Protection could actually provide the means by which vulnerable people would be pushed into death, making a mockery of its name.

6.  THE GOVERNMENT'S STATED "OPPOSITION TO EUTHANASIA"

  6.1  The Government has repeatedly claimed that it is not in favour of legalising euthanasia. [30][31]However, in supporting the provisions of the MIB, the Government is also supporting the killing by neglect of the most vulnerable of people. The Government has claimed that this killing by neglect is not euthanasia, because it defines "euthanasia" very narrowly as:

    A deliberate intervention undertaken with the express intention of ending a life[32]

  6.2  The claim that killing by starvation and dehydration is not "euthanasia" because it involves withholding or withdrawing "treatment" rather than initiating it, is untenable. Killing by starvation and dehydration is just as much euthanasia as giving a lethal injection, and the intent to cause the patient's death because his or her life is regarded as having no value is identical.

  6.3  If the Government is truly serious in its stated opposition to euthanasia, and really wants to advance the true best interests of people who are mentally incapacitated, it should make it clear that whatever a person may have requested in an Advance Directive, there is no such thing as a "life not worth living" and that Advance Directives with a suicidal intent ought not to be acted upon. Incapacitated people, like all human beings, are entitled to the best available treatment, given in their clinical best interests.


Published by the BMA 1999.

  6.4  The draft MIB provides for punishment of a person "ill treats or wilfully neglects" a mentally incapacitated person in his or her care, but allows withholding or withdrawing food and fluids with the purpose of ending life. Starving and dehydrating a vulnerable person to death is in itself "wilful neglect."

7.  DEFINITIONS USED IN THE MIB

  7.1  It has been noted that following the Bland and Law Hospital decisions assisted food and fluids are regarded as "medical treatment" which can legitimately be refused in advance. I suggest that this is not a helpful way to approach and manage disabling conditions.

  7.2  Food and water are basic human necessities, and the European Convention on Human Rights has ruled that there is no "right to die" implicit in Article 2 of the Human Rights Act 1998 which states that "everyone's right to life shall be protected by law. No one shall be deprived of his life intentionally."[33] I suggest that the draft MIB is incompatible with provisions in the ECHR and the Human Rights Act to provide "practical and effective protection of the right to life."[34]

  7.3  I anticipate that the objection that will be raised to point 7.2 is the case of Mrs M and Mrs H in which Dame Elizabeth Butler-Sloss ruled that the two women were enduring a "living death" and should be "allowed to die with dignity."[35]

  7.4  Dame Elizabeth said that this was not contrary to Article 2 of the Human Rights Act (the right to life) or Article 3 (Freedom from degrading or inhuman treatment or torture) because the decision to deny them food and water was consistent with the Bolam test[36]—ie that it was a decision taken by a doctor in accordance with the "accepted professional view and practice of a body of doctors skilled in that area of medical practice." However, Bolam is only a test of clinical negligence, not a test of criminal homicide, a point which Dame Elizabeth appeared to overlook in her judgement. Profoundly disabled people have the same right to life as everyone else, and do not achieve "dignity" only in death, as Dame Elizabeth implied.

  7.6  The Making Decisions leaflets issued by the Lord Chancellor's Department in April 2002 refer to assisted food and fluids as "artificial means" of keeping a person alive. The term refers to Court decisions that "artificial nutrition and hydration" are "medical treatment." The MIB allows Advance Directives which refuse in advance "life prolonging treatment" (10.4.b).

  7.7  Even the British Medical Association, which supports killing vulnerable people by starvation and dehydration, has admitted that

    It is recognised that neither the nutrition nor the hydration is, in fact, artificial, although the method of delivering it is[37]

  7.8  Food and fluids have the same purpose for profoundly disabled people as for all other human beings (indeed for all living things). The need to be assisted with nutrition does not render food and fluids "artificial."

  7.9  There is nothing "artificial" about tube or PEG feeding. As the social commentator Melanie Phillips has noted with reference to Tony Bland:

    The proper analogy . . . would be some kind of mechanical device to digest food if the stomach had packed up. Mr Bland's digestive system still works; he simply cannot feed himself. As a result he depends on others to get the food inside him . . . if someone had suffered, say, a catastrophic stroke and was entirely dependent on others to feed him with a spoon, we would say that was merely assisting him to be fed . . . it is surely perverse to conclude that this particular manner of assisting him to be fed transforms nutrition into medical treatment[38]

8.  A PERSONAL FEAR

  8.1  The problems I raise in these comments have a particular personal resonance for me. As stated earlier I have spina bifida, emphysema and osteoporosis, and use a wheelchair full-time. Eighteen years ago I decided I wanted to die, due to a combination of severe physical pain and other factors. It was a settled wish that lasted about ten years, and during the first five of those years I made serious suicide attempts several times. I was saved only because my friends refused to accept my view that my life had no value, and made sure I was given emergency treatment in hospital, which was given against my will. Then I was extremely angry with them; now I am eternally grateful. It should be noted that my physical pain is now as least as bad as it was then. Then, as now, when my pain is at its worst I cannot move, speak or think and this can go on for hours, with no prospect of relief. Indeed it is almost certain that the pain will get worse. What has changed is not my medical condition, but my outlook on life.

  8.2  If Advance Decisions had been legally binding then, I have no doubt that I would have written one. I would not have received the emergency treatment that saved my life, in accordance with my wishes expressed in advance, and would thus have been denied the chance to re-establish a sense of the value of my life. I sincerely "wished" to die and "felt" my life had no value, but, as often happens, those "wishes and feelings" did not correspond with what was truly in my best interests. The draft MIB fails to point this out—indeed it strongly implies that any sensible person would possess an Advance Decision to be acted upon in case of mental incapacity.

  8.3  The draft MIB would add more categories of people to those doctors already push into death because of a judgment that they have no value and are "better off dead." I am painfully aware that members of the medical profession already abort babies with my condition, up to the moment of birth, and that members of this Government, including the Prime Minister Tony Blair, voted for that to be allowed. I also know that newborn babies are not infrequently sedated and starved to death by doctors, solely because they would otherwise grow up to be like me.

  8.4  I am genuinely frightened about what would happen to me if I were to become mentally incapacitated and unable to speak for myself. Doctors are already demonstrating every day that they are prepared to kill those like me, for no other reason than that they are like me. If the draft MIB becomes law, doctors would seem to have every justification for killing me were I to be unable to speak for myself.

9.  A REQUEST TO THE GOVERNMENT

  9.1  I appeal to the Government to act to protect the true, clinical, best interests of the most vulnerable people in our society, and to make provisions for the most profoundly disabled people to be protected from the harm of being starved and dehydrated to death. Unless it does so, this Government will be guilty of killing in the name of 123"protection"—a contradiction in terms and the most serious derogation of its duty of care for those who cannot speak for themselves.

August 2003






11   Re F (Mental Patient; Sterilisation) [1990] 2 AC1, 78. Back

12   Airedale NHS Trust v Bland [1993] AC 789. Back

13   "Coma blunder ends in horror" by Zoe Brennan The Sunday Times 21 February 1999. Back

14   "The coma girl who refused to die" by Sean O'Neill. The Daily Telegraph 11 June 1998. Back

15   Report of the House of Lords Select Committee on Medical Ethics 1994 (Session 1993-94, HL 21-I). Back

16   Making Decisions: Leaflet 4 "A Guide for Legal Professionals" 1992. Back

17   Airedale NHS Trust v Anthony Bland [1993] AC 789. Back

18   Re: T (Adult: Refusal of Treatment) [1992] WLR 782. Back

19   Re: C (Adult Refusal of Treatment) [1994] WLR 290. Back

20   Re: AK [2001] FLR 134 E-G. Back

21   Airedale NHS Trust v Bland Ibid. Back

22   "Judge says coma woman should be allowed to die" by Gillian Bowditch, Scotland Correspondent. The Times 25 April 1996. Lord Cameron of Lochbroom said that Law Hospital in Strathclyde could stop "artificially feeding" Mrs. Janet Johnston, a 53 year old woman who was in PVS for four years. Her food and fluids were withdrawn and she died 15 days later in May 1996. It was Scotland's first such case. Back

23   B.P. Gardner, F. Theocleous, J.W.H. Watt & K.R. Krishnan. Ventilation or dignified death for patients with high tetraplegia BMJ 1985, 291: 1620-22. Back

24   Melinda Lee. Do patients' treatment decisions match advance statements of their preferences? Journal of Clinical Ethics 09:03 (Fall 1998) 258-262. Back

25   Debate on Mental Health in the House of Lords. Hansard 18 December 2002. Column 766. Back

26   Report of the Select Committee on Medical Ethics. Printed 31 January 1994. Paragraphs 263 and 264. Back

27   "Refusal of Treatment" End of Life Decisions: Views of the BMA. June 2000. Back

28   BBC Press Release on publication of the Government's Mental Incapacity Bill 27 June 2003. Back

29   Withholding or Withdrawing Life-prolonging Medical Treatment: Guidelines for decision making. Back

30   Making Decisions the Government's proposals for making decisions on behalf of mentally incapacitated adults, published in October 1999, contains the statement "The Government wishes to make absolutely clear its complete opposition to euthanasia which is, and will remain, illegal". Back

31   The Parliamentary Secretary to the Lord Chancellor's Department, Baroness Scotland of Asthal said "We are determined that our proposals should not lead the way-through the back or any other door-to euthanasia. The noble Baroness (Baroness Finlay of Llandaff) may be confident that this is not our intent." House of Lords debate on Mental Incapacity 18 December 2002. Hansard Col. 774. Back

32   Letter from Simon Vinogradoff, Medico-Legal Branch, Family Policy Division, Lord Chancellor's Department to Alison Davis 29 November 1999. Back

33   European Court of Human Rights ruling on the case of Diane Pretty 29 April 2002. Back

34   Human Rights Act 1998. Back

35   "Court says `living death' two may die" by Andrew Norfolk. The Times 7 October 2000 "Rights Act does not bar mercy killing" by Frances Gibb. The Times 26 October 2000. Back

36   Bolam v Friern Hospital Management Committee [1957] 1WLR 582. Back

37   Guidelines on Withholding or Withdrawing Life-Prolonging Medical Treatment. Paragraph 3.4 p. 7. British Medical Association 1991. Back

38   "When grief should not be the key" by Melanie Phillips. The Guardian. 27 November 1992. Back


 
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