How many people could be affected?
There may be as many as 24,000 patients in the NHS in England in either a permanent vegetative or minimally conscious state. The estimate made by Prof Derick Wade, a consultant in neurological rehabilitation in Oxford, of those suffering such “prolonged disorders of consciousness” has been widely accepted. Another estimate, which includes those in nursing homes, suggests there could be as many as 64,000 people.
Will the supreme court ruling alter how all those cases are handled?
If a patient has signed a detailed and explicit “advance decision to refuse treatment” form before becoming unconscious, then there was never any need to go to court. Their life support machine can be turned off in accordance with their previously stated wishes. Michael Culver, a director at Solicitors for the Elderly, said: “The case law here goes to show the importance of making a ‘health and welfare lasting power of attorney’ and taking professional advice regarding whether to grant someone the power to make decisions over life-sustaining treatment.”
In cases where the family disagree among themselves or with doctors, an application will still have to be made to the court of protection to resolve the dispute. There have only been about 100 applications over the past 25 years because of the cost and time-consuming litigation involved.
What type of conditions are likely to be involved?
Mr Y had suffered a heart attack, but in the advanced stages of a degenerative neurological condition such as Huntington’s disease or multiple sclerosis, or dementia, there may be a recognised downward trajectory. The BMA is expected to issue fresh guidance to doctors on treatment later this year.
Will there be a mass ending of clinically assisted nutrition and hydration (CANH) treatment?
Supporters of the supreme court judgment accept that it could lead to many people who had been kept alive against the wishes of their families and doctors now having food and water withdrawn, leading to their deaths.
David Foster, at the law firm Barlow Robbins, acted for the campaign group Care Not Killing which intervened in the case. He fears a “worst case scenario” of the mass ending of treatments, but he hoped that doctors and family members would ensure that did not happen. “These patients are some of the most vulnerable people,” he said.
Is it question of resources?
Dr Peter Saunders, the campaign director of Care Not Killing, claimed that saving money could add to the pressure on families to withdraw treatment. “Given that it costs about £100,000 per year to care for a person with persistent vegetative or minimally conscious state, the potential ‘saving’ for the NHS could be as much as £2.4bn annually if most seek to go down this route,” he said.