On 28 September 2011, a High Court judge, Mr Justice Baker, had to decide whether an unnamed 52 year old woman, who was in a “minimally conscious state”, should be allowed to have her life-supporting treatment withdrawn so she could die.

The woman’s family argued that, as she was in pain and did not have a good quality of life, she should have her artificial feeding and hydration withdrawn. They maintained that she would not wish to live a life that was dependent on others. The family’s arguments were contested by the local health authority responsible for commissioning her care, who opposed the application on the basis that she was on the “edge of awareness” and that her life was “not without positive elements”.

The case should be distinguished from others where patients have had life sustaining treatment withdrawn. This woman was minimally conscious, whereas in the other cases, the patients were in a persistent vegetative state.

Mr Justice Baker noted that the case raised very important issues of principle that needed to be addressed for the sake of other patients in a similar position. The Judge explained that, in his view, the most persuasive factor in the case was the preservation of life. He commented “although it is not an absolute rule, the law regards preservation of life as a fundamental principle”. He found that the woman had some positive experiences which could be extended by a planned programme of increased stimulation. On this basis he decided that it was not in the woman’s best interests for the treatment to be withdrawn.

The implications of this decision are not yet clear. The woman’s family were adamant that she would not have wanted continued treatment given her poor quality of life. Her wishes, however, were not clear and the case underlines the need to make an advance decision recording one’s wishes. The decision also made it clear that the withdrawal of life-sustaining treatment in a patient’s best interests required the permission of the court.