No duty to ‘needlessly prolong dying’

Posted: 1st March 2013

In opening the way for a desperately ill but much-loved father-of-three to ‘die with dignity’, the Court of Appeal ruled that doctors are under no duty to prolong human life at all costs nor ‘needlessly to prolong dying’ regardless of patient suffering or a lack of therapeutic benefit in on-going invasive treatment.

Hospital SignProfessional guitarist, David James, 68, died on New Year's Eve 2012 after his wife and daughter failed to convince the court that he should be given life-saving treatment to the end. The family argued that, although struck silent by his multiple illnesses, Mr James was well enough to enjoy his golden wedding anniversary celebrations in September 2012 and was able to respond in a variety of ways to the world around him, including smiling and laughing.

At first instance, a family judge had refused to grant permission to the Aintree University Hospitals NHS Foundation Trust to issue a ‘do not resuscitate’ notice and to withdraw further invasive medical treatment from Mr James. The trust’s appeal against that decision was upheld on December 21 2012 after an emergency hearing on the final day of the legal term before Christmas.

Giving reasons for that decision, the court gave guidance for the future handling of such cases. It accepted the trust's plea that further invasive treatment of Mr James would have been ‘futile’ and that it was not the proper role of doctors to ‘delay death’ if such treatment could bring no improvement to a patient’s condition and could only serve to lengthen his or her suffering.

‘There is no duty to maintain the life of a patient at all costs. There is no duty needlessly to prolong dying’, the court stated, also noting that even those who believe that human life is itself a basic intrinsic good do not support the 'vitalist' view that, regardless of the pain and suffering that life-prolonging treatment entails, it must be administered on the basis that human life is to be preserved at all costs.

Lord Justice Ward observed: "It is difficult to deny that there is implicit in every judgment about whether treatment is futile or worthwhile a judgment about the quality of life the patient will have with or without any treatment. Like it or not, lurking within the question, or perhaps behind it, is the ethically controversial question: is it worthwhile keeping this patient alive?”

The judge acknowledged that a patient's wishes in respect of his or her treatment, if they are capable of being expressed, ‘have a part to play’ in clinical decisions. However, he said that they cannot always dictate the final answer to the question of what is in a patient’s best medical interests.

The court paid ‘respectful tribute’ to Mr James' family, saying that they had won the court's admiration for their devotion to him, but upheld the trust's arguments that further invasive treatment would be ‘unduly burdensome’. Mr James had enjoyed 10 more years of happy life with his family after beating colon cancer in 2001 but his health deteriorated in May 2012 and he was admitted to hospital. There, he swiftly became extremely unwell after picking up an infection. By late June 2012 he was suffering from hospital-acquired pneumonia and multiple organ failure and he later became entirely dependent on life support. Despite being fed a range of antibiotics, he endured chronic infections about twice-a-month and suffered brain damage.