[2012] All ER (D) 146 (Nov)

Medical treatment – treatment withdrawal

Summary and comment

Following a cardiac arrest, J was in a permanent vegetative state (‘PVS’). A therapy assistant’s student recorded in a diary that during treatment J had verbalised that she wanted to die and then repeated ‘die’ ten times; whereas the assistant’s account was that J made and repeated a sound like ‘die’. In an ex tempore judgement, Roderic Wood J. distinguished between ‘verbalisation’, which did not occur when a patient was in a PVS, and ‘vocalisation’, a moan or groan often repeated and seen in PVS and other conditions. It was improbable that J was capable of forming a sentence, however simple and her vocalisation had been innocently misinterpreted. It did not indicate a level of awareness consistent with a minimally conscious state (‘MCS’) and declarations and orders were granted for artificial hydration and nutrition to be lawfully withdrawn.

We mention this case because clearly the verbal/vocal distinction will be an important factor in the PVS/MCS distinction.