Preston court to rule on 'right to die' case

Her family is in dispute over the ongoing care of the woman who has no capacity to make any decisions about her health, a court has heard.

The pensioner, who can only be identified as Mrs P, is said to be in a "minimally conscious state" on an acute hospital ward following a fall last year.

A Court of Protection judge is being asked to consider whether Mrs P should continue to receive clinically assisted nutrition and hydration.

The woman's daughters and her partner all consider it would not be in her best interests and she should be provided with palliative care.

But her sisters disagree and say an artificial feed should be maintained to see whether she might improve further.

The hearing in Preston was told of an email that Mrs P sent to one of her daughters more than three-and-a-half years before her fall.

It read: "Did you see that thing on dementia? Made me think of dad and what a travesty of life his last years were all the sadder as he had such an incredible talent.

"You know I miss Mum everyday and still talk to her but it is a comfort that she went quickly and I'm still haunted by how he ended up ... Get the pillow ready If I get that way?"

But the sisters say their sibling would have wanted the opportunities to progress and improve.

One of the sisters thought the withdrawal of feeding would amount to a form of "legalised killing", while another said the medical profession should be the judge of what treatment is provided.

The NHS foundation trust which is treating Mrs P has applied to the court to continue providing clinical treatment and transfer Mrs P to a specialist nursing home.

Joseph O'Brien, for the NHS trust, told Mr Justice Hayden: "Very early on Mrs P's daughters were expressing the view to the clinicians that she would not wish to have any treatment which would continue her existence, her life, if she in fact was suffering from brain damage."

He said witness evidence from friends and neighbours, with recollections of specific conversations, would also set out what the woman would wish to happen to her "in the event she found herself either with dementia or with any cognitive problems".

But he added: "There is a strong presumption about the preservation of life.

"On the evidence we've seen so far there is nothing that's strong enough to rebut the notion that in the circumstances she currently finds herself, she would wish treatment to be discontinued."

Two medical experts who have looked at the case agree there would be no further change in Mrs P's underlying neurological and neurophysiological state.

They also agree there would be no significant improvement in terms of underlying levels of awareness and responsiveness

But both have different opinions on whether nutrition and hydration should continue.

One says she believes there is a reasonable prospect that in a different environment Mrs P would become more interactive with other people, and that Mrs P does at time show pleasure and does engage with therapy, nursing and medical staff.

But the other expert feels that Mrs P shows evidence of distress and not wishing to engage socially, at least from time to time.

He also does not agree that Mrs P will have a marked improvement in her level of social engagement and quality of life in a different setting.

The hearing continues.

Usha Grieve, Director of Information & Partnerships at Compassion in Dying, said: “This case is tragic and no doubt deeply upsetting for Mrs P’s family, who have already suffered the heartbreak of seeing her sustain such a serious brain injury. Mrs P’s family are now having to endure further distress due to a disagreement over whether she should continue to receive life-prolonging treatment.

"No one plans to have an accident or become unwell – but there are things you can do now to help ensure that what has happened in this case does not happen to you and your family. An Advance Decision, also known as a Living Will, is a legally-binding document that allows you to state whether you would want to refuse life-prolonging treatment should you later become unable to make or communicate these decisions for yourself. Rather than leaving these choices up to doctors or family members who may disagree over what you would have wanted, making an Advance Decision means that you can remain in control of future decisions about your care and treatment and feel reassured that your wishes will be followed, even if tragedy strikes."