A man who fears doctors could deny him life-prolonging treatment has won his legal challenge against existing medical guidance.
Leslie Burke, who has a degenerative brain condition, feared doctors could withdraw food and drink against his wishes when he can no longer speak.
Current guidelines state that if patients are no longer able to communicate their views, doctors must judge what the patient would want, based on earlier discussions or written statements and in consultation with patient's relatives.
Mr Burke and his supporters argued that this should be changed so that doctors will have to presume a patient wants to carry on living.
The ruling will affect patients who are terminally ill and those with a disability who are unable to communicate their wishes about their treatment.
This ruling goes part of the way to undoing the harm brought on by the Tony Bland case, which rules that assisted feeding and drinking is medical treatment and could be subject to the futile therapy test. As an anaesthetist, I would certainly think twice if I had to give a risky anaesthetic to enable procedures to be carried out for feeding a patient, but I have never been happy with their Lordships' view that it is OK to stop feeding someone and pull out a perfectly functional feeding tube. Tube feeding and the like should be viewed as basic human needs and should be considered quite separate from medical therapy. Let's hope this ruling goes some way towards making and maintaining this distinction.
Dr Peter Au-Yeung, Hong Kong (ex-UK)
It is good to see the courts exhibiting common sense. Do not doctors and medical professionals undertake to save and maintain life?
Tony, Swansea, Wales
The difference between having a life to live and living it is not lost on most people. The issue here is more about choice. More than anything, it is having a choice that gives dignity to human life. This holds true for those who choose life, as it does for those who choose death.
Bronne Dytoc, Pasig, Philippines
The right to life is all well and good if that life is worth having. I worked for twenty years in the NHS, and saw people die in the utmost agony because 1. Doctors were afraid to prescribe Diamorphine because of potential addiction problems, 2. Nurses were indifferent to patients' claim of pain and would report that they are just putting it on! Better to die at one's choice then later in screaming agony because of others choices.
John, Hailsham. E. Sx
It is refreshing to have a person with a degenerative disease grab the headlines for saying they want to live, rather than protesting that they are not allowed to die. I hope Mr Burke's stand will encourage those who are facing such a decline in their health, and undermine popular support for euthanasia.
Heather, Stockport, UK
The judge is correct in his observation that errors are creeping in. As soon as one sweeps away the assumption that the patient wants to live, the doctor becomes God. Since no doctor is likely to have the benefit of omniscience in "...judging what the patient would want..." this is a really scary scenario.
SJ Schuilenberg, Kelowna Canada
This case portrays doctors as going around the wards, looking for patients whose food and water can be switched off. From my own observations I can assure these decisions don't take place like this. If patient's will is known it is honoured, otherwise the decision is made after discussion with family and with their approval. I don't understand what this new ruling will bring to patient's rights.
Dr Asim, Manchester
As someone who has recently suffered a stroke at 54, I consider Mr Burke to be an extremely selfish individual. Perhaps - if he did not have his current degenerative brain condition - he would appreciate the problems caused to his family by his wish for eternal life at their expense and inconvenience.
David Russell, Alozaina, Spain
This case was just about one man trying to make a political statement. A simple document would have sufficed to communicate his wishes, instead of which he has complicated the lives of many.
Matt, Amsterdam, Netherlands (ex UK)
The problem is that this ruling is now going to be trotted out by those religious fanatics who consider their principles to be more important than the suffering of others. Leslie Burke is perfectly within his rights to insist he be allowed to carrying on living for as long as possible and surely is in a position to leave written, videoed instructions to that effect (though what kind of life he could lead when the disease has taken full hold of him is beyond me).
Neil, Southend, UK
I have no problem with someone wishing to prolong their life after doctors would have stopped providing nutrition. What I do have a problem with is paying for it. The NHS is already overstretched and spending (and wasting) a lot of money as it is. For the taxpayer to have to carry this extra burden is unfair. At the point when doctors would normally stop treatment then the patient should start paying.
The problem is that the only way a doctor can legally assist a patient to die is to withdraw food and fluids. It cannot be a nice way to go and I would certainly not want to be starved to death or forced to die from dehydration. But in the absence of an alternative it will continue so I think Mr Burke was right to bring this case.
To presume one way or the other seems unnecessarily rigid. If the patient's views are known before he/she becomes unable to communicate, then those are paramount and the guidance seems to already cover this.
Katherine, London, UK
This ruling only serves to further muddy the waters. We now need clear legislation and guidelines for relatives, doctors and patients.
Fletcher, Poole, UK
At the end of the day, a doctor's presumption that a patient does not want to die is probably more likely to be down to saving money and freeing up beds for other patients rather than any other reason. If we live with a government determined to meet fancy targets, curb spending (unless on pen pushers of course) then pressures to free up resources will always force doctors into these types of decisions.
Dave, Newcastle Upon Tyne, England
The real problem is not with medical ethics but with abuse of the law. There is already a clear law covering exactly this man's, and his doctors', situations so this entire case is unnecessary and frivolous.
Stephen Brooks, York, England
About time too. Seems to me that GMC advice constantly goes against the wishes of terminally ill patients: denying the right to live in this case, and refusing to allow euthanasia to those who would choose it rather than live a half life!
Helen Shepherd, Wigan, UK
It's your life and you should have the right to both prolong it and shorten it as you see fit.
Phillip Holley, Cambs, UK
If a person has not been able to communicate their wishes then doctors should do everything possible to keep the person alive. However, if the person has been able to communicate that they would prefer to live/not live while they are still capable of doing so then doctors must honour this. I have made it very clear to my wife that if I were to suffer a serious condition that would destroy my quality of life and from which I was unlikely to recover, that treatment should be withheld rather than just using it for the sake of keeping me alive.
Why change the law? Currently it says that doctors "judge what the patient wants based on previous discussion". Mr Burke in previous discussions has clearly said "don't let me die". That should be the end of the matter. Instead we get new laws prolonging the suffering of people who may want to die. This is not a step forward.