Airedale Nhs Trust V Bland Notes

Airedale NHS Trust v Bland [1993] AC 789

House of Lords

Held Lord Keith

• The object of medical treatment and care is to benefit the patient.

  • It may do so by taking steps to prevent the occurrence of illness, or, if an illness does occur, by taking steps towards curing it.

  • Where an illness or the effects of an injury cannot be cured, then efforts are directed towards preventing deterioration or relieving pain and suffering

• Given that existence in the persistent vegetative state is not a benefit to the patient, does the principle of the sanctity of life,

  • which it is the concern of the state, and the judiciary as one of the arms of the state, mean that treatment must be continued?

  • The principle is not an absolute one. It does not compel a medical practitioner on pain of criminal sanctions to treat a patient, who will die if he does not, contrary to the express wishes of the patient.

    • It does not authorise forcible feeding of prisoners on hunger strike.

    • It does not compel the temporary keeping alive of patients who are terminally ill where to do so would merely prolong their suffering.

      • On the other hand it forbids the taking of active measures to cut short the life of a terminally ill patient

  • The decision whether or not the continued treatment and care of a P.V.S. patient confers any benefit on him is essentially one for the practitioners in charge of his case.

    • The question is whether any decision that it does not and that the treatment and care should therefore be discontinued should as a matter of routine be brought before the Family Division for endorsement or the reverse.

Held Lord Goff

• I start with the simple fact that, in law, Anthony is still alive. It is true that his condition is such that it can be described as a living death;

  • but as a result of developments in modern medical technology, doctors no longer associate death exclusively with breathing and heart beat,

  • and it has come to be accepted that death occurs when the brain, and in particular the brain stem, has been destroyed

  • Here, the fundamental principle is the principle of the sanctity of human life - a principle long recognised not only in our own society but also in most, if not all, civilised societies throughout the modern world

    • But this principle, fundamental though it is, is not absolute. Indeed there are circumstances in which it is lawful to take another man's life, for example by a lawful act of self-defence

    • We are concerned with circumstances in which it may be lawful to withhold from a patient medical treatment or care by means of which his life may be prolonged.

      • But here too there is no absolute rule that the patient's life must be prolonged by such treatment or care, if available, regardless of the circumstances

• General Principles

  • First, it is established that the principle of self-determination requires that respect must be given to the wishes of the patient,

    • so that if an adult patient of sound mind refuses, however unreasonably, to consent to treatment or care by which his life would or might be prolonged,

      • the doctors responsible for his care must give effect to his wishes, even though they do not consider it to be in his best interests to do so.

  • But in many cases not only may the patient be in no condition to be able to say whether or not he...

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