BBC NEWS Americas Africa Europe Middle East South Asia Asia Pacific
BBCi NEWS   SPORT   WEATHER   WORLD SERVICE   A-Z INDEX     

BBC News World Edition
 You are in: Talking Point: Forum  
News Front Page
Africa
Americas
Asia-Pacific
Europe
Middle East
South Asia
UK
Business
Entertainment
Science/Nature
Technology
Health
-------------
Talking Point
Forum
-------------
Country Profiles
In Depth
-------------
Programmes
-------------
BBC Sport
BBC Weather
SERVICES
-------------
EDITIONS
Thursday, 7 March, 2002, 11:21 GMT
Six Forum: The right to die
Penney Lewis, lecturer at the Centre of Medical Law and Ethics at King's College, London, answered your questions in a live forum for the BBC's Six O' Clock News, presented by Manisha Tank.

To watch coverage of the forum, select the link below:

  56k  


A fully conscious but paralysed woman is asking the UK High Court for permission to turn off her hospital ventilator.

The woman, who cannot be identified, has been paralysed since rupturing a blood vessel in her spine a year ago.

Her condition is stable, but her chances of improvement are put at under 1%.

The woman's lawyer says his client is in full possession of her mental faculties, and is competent to make a decision.

But her doctors say their ethical training would not allow them to switch off the ventilator, and that she cannot make a truly informed decision about her quality of life.

Who has the right to make the final decision on whether you live or die?



Newshost:

The right to die is an issue that has hit the headlines as a paralysed woman goes to the High Court to argue her case. We're going to put your questions to Penney Lewis and talk about the ethical and legal implications of this case. First of all, let's lay out the legal position behind this case that has hit the High Court.


Penney Lewis:

The woman, who is paralysed from the neck down, is claiming the right to have her ventilator turned off. Legally she does have the right as a competent adult to the removal of life-sustaining or life-saving treatment. So the only legal question facing the High Court is whether or not she is in fact competent.


Newshost:

Liam Murray, Scotland: Surely it is an inherent part of any right that an individual has a choice about whether or not to exercise that right. By implication anyone who has a right to life has an automatic right to end that life or cease to exercise their right to it?


Penney Lewis:

I think in this context, where the right is a right to refuse medical treatment, that would actually be a correct statement of English law. So that she does have a right to life but she also has the right to waive that right in as much as she can waive the right to medical treatment, which is keeping her alive.


Newshost:

Angela, UK: How is it that a relative can decide that the life support machine of a loved one can be switched off? The only difference here is that she is making the decision for herself.


Penney Lewis:

If we're talking about an adult who is on a life-support machine, that adult has a right to refuse to have the life support continue. If that adult were, for example, unconscious, it's not in fact the case that a relative can choose to terminate the life support. The test is the test of best interest, which is the same test that you hear in cases involving children and it will be for the doctors to decide whether or not to continue treating that patient, who is unconscious, is in her best interest or not. If the doctors and the family disagree then a court may step in and make that decision but it's not the case that as a relative one has the right to terminate life support of a loved one.


Newshost:

Vikram, London, UK: Would her family be able to contest the decision if the court agreed and they didn't?


Penney Lewis:

Her family wouldn't have any legal role in the decision. It may seem unfortunate to state it so bluntly but it is the case that families don't have standing to challenge decisions involving competent adults. Certainly one would hope that in this case and in most cases, there will have been consultation with the family - that's certainly good medical practice and I'm sure the doctors are doing that here and that the family will be consulting with both their loved one and their doctors in order to try and achieve a negotiated settlement. Obviously in this case, thus far, that hasn't happened.


Newshost:

Text message J. Ferguson in Aberdeen: No individual should have the right to choose death over life, that is for the law and they should give a firm decision not a choice to the patient.


Penney Lewis:

I certainly can see that position as being a strongly held one, it's not actually consistent with the legal position which has been very clear in this country for many years, since long before the advent of the Human Rights Act, which is that competent adults have the right to refuse life-saving treatment - in fact to refuse any treatment, including life-saving or life-sustaining treatment - even when that refusal will result in death.


Newshost:

David, England: Could a compromise be reached where she should at least try treatment for about six months. If after that she still wants to die, she should be allowed to do so.

Another e-mail from Liz Cole, UK: I feel that it is the person's decision. I've been suffering from a terminal illness now for 20 years and would never have started the treatment I have been receiving if I'd known that the drugs and the operations would be worse for me than the original problem.


Penney Lewis:

As I said at the beginning, the only legal issue here is competence. So the question is, is she competent? In order to decide that, the court will be looking to see whether or not she understands and retains the information relevant to her decision and she has the ability to use that information in order to reach a decision weighing up the pros and cons. I imagine the doctors here are arguing that she doesn't really understand the information relevant to her condition, including her prognosis, because she hasn't yet tried rehabilitation. Now that may be an argument which the court is willing to accede to in order to avoid what may be quite an unpalatable decision for the judge to make.

But I certainly think that the second e-mail, from the woman who is suffering terminal disease, indicates that there is a concern in terms of forcing people to have treatment in order to try it out before we let them refuse. Generally, the position is as long as they understand the ramifications of their decision and their prognosis, they can refuse in advance of having any treatment.


Newshost:

An e-mail from Marilyn Barton, UK: I, like Diane Pretty, suffer with motor neurone disease. I believe it is completely out of order for doctors, courts and even relatives and friends to think that they may have the right to know what is best for those individuals who are suffering this fatal disease - it takes away any quality of life.


Penney Lewis:

I think that is an interesting point because it points out the difference between this case and the Diane Pretty case. Diane Pretty was seeking to have her husband assist her in suicide. Now assisting suicide is a crime under English law punishable by 14 years imprisonment. Withdrawing life-sustaining treatment is not in any way a criminal activity and it is indeed the patient's right. So patients who are, for example, on a ventilator, can refuse that ventilator and thereby die. But patients who are not on a ventilator - like most patients with motor neurone disease - don't have the option under English law because the active step of assisting someone in a suicide is viewed very differently from the more passive step of simply from refraining from ventilating someone or assisting them with their breathing.


Newshost:

Clare Lewis, UK: I am disabled activist - death will not bring this woman quality of life and I'm not surprised she feels like that stuck in the hospital. Shouldn't she be requested to at least try independent living before making such a huge decision?


Penney Lewis:

I imagine that the doctors have tried very hard to convince her of that and again legally the only way to prevent her from making this decision is to say that's she is not competent - she doesn't understand what it would be like to try independent living, for example, and therefore can't make this decision yet. But if the court finds that she is competent, then she cannot be forced to try independent living or rehabilitation before making her decision.


Newshost:

Charles Pinkerton, UK: Is there a legally distinct boundary between self-ownership and state control of the human body?


Penney Lewis:

That's quite a big question. I think in this case, the law is very much in favour of self-determination. When we're talking about the right to choose whether or not to accept medical treatment - if you're a competent adult you have that right - therefore you are in effect determining what invasions of your bodily integrity are going to be permitted in order to help you.

State control of the human body - well, I suppose one argument that might be made in the context of motor neurone disease is that by preventing assistance in suicide the state is in effect controlling the body of the person suffering from the disease. I think the state would view it more as the need to protect vulnerable individuals from the possibility of abuse that may occur in the context of assisted suicide or euthanasia.


Newshost:

Text message from Steve Hawkins, UK: Right to die? No way. The start of a slippery slope - we are not God.


Penney Lewis:

I think it's interesting to think about this as the start of a slippery slope because it's actually a slope that we've gone quite a long way down. The way we've tried to navigate down this slope is to put a very clear stop at the point where the patient can control what happens to her body in terms of refusing or accepting medical treatment but can't request active intervention like euthanasia or assisted suicide. So we're already down that slippery slope to a certain extent.


Newshost:

To conclude, in terms of though we don't know what will happen so far as the case is concerned, from the reports that we're getting, are we getting an idea about this issue of competency?


Penney Lewis:

The judge who is deciding in this case is a judge who is very clear that a competent adult has a right to refuse medical treatment. She is a judge that has been involved in cases involving competent pregnant women who are refusing medical treatment which may help to save the life of their foetus and has ruled in favour of the pregnant woman making those decisions. So I think if she finds this woman competent, there's no question that the decision will be reached that she can choose to refuse life-sustaining treatment. I don't really see a significant ground for finding her incompetent but I haven't had the benefit of hearing the medical evidence. So maybe there will be something in that evidence which would indicate that she's not fully able to appreciate her condition, but that that would be the only route available to the judge.

See also:

06 Mar 02 | Health
23 Jan 02 | Health
04 Oct 01 | Health
06 Oct 00 | Health
Internet links:


The BBC is not responsible for the content of external internet sites

Links to more Forum stories are at the foot of the page.


E-mail this story to a friend

Links to more Forum stories

© BBC ^^ Back to top

News Front Page | Africa | Americas | Asia-Pacific | Europe | Middle East |
South Asia | UK | Business | Entertainment | Science/Nature |
Technology | Health | Talking Point | Country Profiles | In Depth |
Programmes