Heywood Rob
UEA Law School, Earlham Hall, Norwich NR4 7TJ, UKE-mail:
Med Law Rev. 2014 Fall;22(4):548-71. doi: 10.1093/medlaw/fwu003. Epub 2014 Mar 11.
The decision in Bland centred on the withdrawal of artificial nutrition and hydration from a patient in a persistent vegetative state (PVS). Since then, a new medical condition has emerged, known as a minimally conscious state (MCS). In W v M, the Court of Protection was asked to authorise the withdrawal of artificial nutrition and hydration from a patient in a MCS. Baker J refused to grant the declaration. More recently, however, the courts were also asked to rule on the lawfulness of withholding treatment in a similar, albeit factually different, case. In the Court of Appeal decision in Aintree University Hospitals NHS Foundation Trust v David James and Others, Sir Alan Ward, with the agreement of Arden LJ and Laws LJ, granted a declaration that it would be lawful to withhold treatment. The Supreme Court then upheld this ruling, Lady Hale stating that the Court of Appeal reached the right result but for the wrong reasons. This article seeks to critically appraise the evolution of the law in regard to withdrawing treatment from MCS patients. The piece begins by explaining the differences between the two conditions of PVS and MCS and defines the law from the starting point of Bland. From here, the discussion progresses to focus on the challenges that the law has had to face in trying to keep pace with the advancing nature of medical understanding of conditions of the brain and explains how it has responded to these. The narrative then critiques the legal mechanism of best interests as it has been employed in the case law concerning MCS patients to date by analysing the various judicial perspectives on the concept. After addressing both the narrow and wide viewpoints, a conclusion is ventured as to how the balancing of best interests should be approached in respect of future MCS cases.
布兰德案的裁决聚焦于停止对处于持续性植物状态（PVS）的患者提供人工营养和水分补给。自那时起，一种新的医学状况出现了，即最低意识状态（MCS）。在W诉M案中，保护法庭被要求批准停止对处于最低意识状态的患者提供人工营养和水分补给。贝克法官拒绝做出该声明。然而，最近在一个情况类似但事实不同的案件中，法院也被要求对停止治疗的合法性做出裁决。在上诉法院对安特里大学医院国民保健服务基金会信托诉大卫·詹姆斯及其他人一案的判决中，艾伦·沃德爵士在阿登法官和劳斯法官的同意下，做出了停止治疗将合法的声明。最高法院随后维持了这一裁决，黑尔女勋爵表示上诉法院得出了正确的结果，但理由错误。本文旨在批判性地评估关于停止对最低意识状态患者治疗的法律演变。文章首先解释了持续性植物状态和最低意识状态这两种状况之间的差异，并从布兰德案出发界定了相关法律。在此基础上，讨论进而聚焦于法律在试图跟上对脑部状况医学理解的发展时所面临的挑战，并解释了法律是如何应对这些挑战的。接着，通过分析判例法中关于最低意识状态患者的各种司法观点，对迄今在判例法中运用的最有利利益法律机制进行了批判。在探讨了狭义和广义观点之后，就未来最低意识状态案件应如何权衡最有利利益进行了大胆的总结。
