Radio Four’s recent File on Four programme, ‘A Living Death’, featured four case histories
of people with serious brain damage. They included Ian Wilson,
an Aberdeen man in his 50s, who suffered a severe head injury in a road accident
21 years ago and is now the longest surviving patient in the UK with vegetative
state. He is looked after at home by his 83 year old mother. A second patient with
the same diagnosis had died after a court ruled that food and fluids could be withheld.

People with so-called
persistent vegetative state (PVS) may live for ten, twenty or thirty years – in
fact the record survival is more than forty. But since the Tony Bland (pictured above) judgement in 1992, in which
the Law Lords ruled that a young man’s nasogastric feeding tube could be removed
with the intention of ending his life, it has been possible in Britain to apply
to the courts to withdraw hydration and nutrition from people who are severely brain-damaged
but not dying.

But this is possible
only for those in PVS. Those will lesser degrees of brain damage cannot have their
lives ended in this way. There are estimated to
be between 1,000 and 5,000 patients with PVS in Britain today, but so far only 43
have died after court rulings allowing feeding tubes to be removed.

This radio programme
was essentially asking two questions:

1.Should we be doing more to encourage families
of those with PVS to go to the courts?

2.Should this form of ending life be extended
to include those with minimal awareness states that are less serious than PVS?

Two doctors were interviewed,
both professors in neurological rehabilitation, Derick
Wade of the Nuffield Institute in Oxford, and Lynne Turner-Stokes of Kings College, London.  Turner-Stokes is the
chair of a committee set up by the Royal College of Physicians to make recommendations
about life-ending protocols for PVS patients. She pointed out the cost of looking
after people so affected – about £100,000 per year – and asked whether this cost
was justified given financial pressures on the NHS. Wade was much more cautious
and warned of the incremental extension that would follow any further change in
the law.

The current law is soon
to be tested by a case brought by the mother of a patient – known as M – who was
left in a ‘minimally conscious state’ following an episode of encephalitis in 2003.
The case has been reported by the BBC and Daily Mail and is to be heard in July this year.

Vikram Sachdeva, counsel
for the mother, argues that M ‘is in a very low level minimally conscious state
with no meaningful interaction with the environment.’ However, the application
is ‘strongly opposed’ by the Official Solicitor, who represents M's interests. This is a landmark case
which, if successful, will radically redraw the law in this country and place the
lives of many more disabled people at risk.

The Bland decision crossed
a legal Rubicon. Withdrawing nutrition and hydration from non-dying patients with
the explicit intention of ending their lives is euthanasia by omission. This case,
however, could take us several steps further down the slippery slope.

I will be watching it
very closely.

Dr Peter Saunders is a former general surgeon and CEO of Christian Medical Fellowship,
a UK-based organisation with 4,500 UK doctors and 1,000 medical students as members.
This article has been cross-posted from his blog, Christian
Medical Comment.