96.Memorandum from Alison Davis (MIB 337)|
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which can legitimately be withheld or withdrawn.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
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
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.
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.
2.1 "Best interests" are generally
understood, as is reflected in case law,
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..
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
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."
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
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
3. THE ROLE
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."
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)  WLR 782)"
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
(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
(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
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.
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 judgementsfood
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
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.
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.
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
peopletowards 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
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
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
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
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 treatmentpresumably
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
4. LASTING POWERS
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
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
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
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
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."
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
6.1 The Government has repeatedly claimed
that it is not in favour of legalising euthanasia. 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
A deliberate intervention undertaken with the
express intention of ending a life
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
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
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."
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."
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 testie
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
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
8. A PERSONAL
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
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 outindeed
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
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.
11 Re F (Mental Patient; Sterilisation)  2 AC1,
Airedale NHS Trust v Bland  AC 789. Back
"Coma blunder ends in horror" by Zoe Brennan The
Sunday Times 21 February 1999. Back
"The coma girl who refused to die" by Sean O'Neill.
The Daily Telegraph 11 June 1998. Back
Report of the House of Lords Select Committee on Medical Ethics
1994 (Session 1993-94, HL 21-I). Back
Making Decisions: Leaflet 4 "A Guide for Legal Professionals"
Airedale NHS Trust v Anthony Bland  AC 789. Back
Re: T (Adult: Refusal of Treatment)  WLR 782. Back
Re: C (Adult Refusal of Treatment)  WLR 290. Back
Re: AK  FLR 134 E-G. Back
Airedale NHS Trust v Bland Ibid. Back
"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
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
Melinda Lee. Do patients' treatment decisions match advance statements
of their preferences? Journal of Clinical Ethics 09:03
(Fall 1998) 258-262. Back
Debate on Mental Health in the House of Lords. Hansard 18 December
2002. Column 766. Back
Report of the Select Committee on Medical Ethics. Printed 31 January
1994. Paragraphs 263 and 264. Back
"Refusal of Treatment" End of Life Decisions: Views
of the BMA. June 2000. Back
BBC Press Release on publication of the Government's Mental Incapacity
Bill 27 June 2003. Back
Withholding or Withdrawing Life-prolonging Medical Treatment:
Guidelines for decision making. Back
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
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
Letter from Simon Vinogradoff, Medico-Legal Branch, Family Policy
Division, Lord Chancellor's Department to Alison Davis 29 November
European Court of Human Rights ruling on the case of Diane Pretty
29 April 2002. Back
Human Rights Act 1998. Back
"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
Bolam v Friern Hospital Management Committee  1WLR 582. Back
Guidelines on Withholding or Withdrawing Life-Prolonging Medical
Treatment. Paragraph 3.4 p. 7. British Medical Association
"When grief should not be the key" by Melanie Phillips.
The Guardian. 27 November 1992. Back