Walking along a very fine line

Roger Pearson reports on two decisions in the emotive area of ceasing to treat coma victims

When the courts finally agreed that Hillsborough victim Tony Bland should be allowed to drift from the persistent vegetative state (PVS) in which tube feeding was keeping him, there was concern that the decision would open a floodgate of similar applications to the courts.

The floodgate did not open. But the legal spotlight is back on this emotive area of the law as the High Court has sanctioned the cut-off of nourishment and life-prolonging medical treatment in two cases.

One of those cases broke new ground in that the the victim's mother opposed any 'cut off' moves. The other case revealed that, despite appearances to the contrary, speedy action is sometimes necessary.

The first case involved a motor cyclist who received devastating head injuries in a 1991 accident. He later underwent cardiac arrest and lapsed into PVS. His wife finally supported doctors in their view that there was no hope and he should be allowed to die with dignity. His mother, however, had opposed this view and referred to it as possibly being akin to euthanasia.

High Court Family Division President, Sir Stephen Brown, stressed in giving leave for the man to be allowed to die, that euthanasia entailed an "evasive event" which would bring about death. Withdrawal of treatment was not the equivalent of euthanasia, he said. He added that it would be an "appalling burden" to leave relatives with the final decision.

In the other case, Justice Ward ruled that a woman who lapsed into PVS after a 1992 operation for removal of a brain tumour should be allowed to die. She had been kept alive by sustenance through a tube inserted through the wall of her stomach. However, an urgent decision was necessary after the tube became blocked and her family did not wish her to undergo surgery to unblock it.

Despite the speed with which the matter was brought to the court the judge said he had no doubt from the expert evidence that there was no hope of recovery and that the wishes of the woman's family should be observed. The Official Solicitor represented the victims in both cases.

The legal teams, some of whom were involved in both cases, included Robert Francis QC, Adrian Hopkins, James Munby QC, Paul Coleridge QC, and Lord Meston, counsel well-known for their specialist skills in such matters.

Dr Keith Andrews, who is recognised as one of the world's foremost experts in the field, prepared evidence in both cases – and emphasised the need in such cases for consultation at the earliest possible moment with the Official Solicitor's office.

"I don't see a flood of such cases, but we have been made aware of a number in which applications may eventually be made," he said.

"It is important that the Official Solicitor is called in as early as possible before any moves are actually made."

The case for the health authority in the application before Justice Ward was prepared by solicitor Tim Wright of Wessex Legal Services. He said it is important to move quickly if the circumstances demand it. When that happens he said the value of having a close working relationship with the Official Solicitors office and knowing the right experts and counsel to call in becomes essential.