The Gazette 1995

GAZETTE

V I E W P 0 I N T

MWH AUGUST/SEPTEMBER 1995

A Right To Die?

The Supreme

Court in

session.

In a landmark decision (in re a Ward of Court) on July 27, 1995, the full Supreme Court (by a four to one majority) upheld the earlier High Court Judgment (Lynch J ) consenting (on the j application of the ward's family) to the withdrawal and termination of abnormal artificial means of nourishment from a ward of court in a near permanent vegetative state ( " PVS " ), thus ceasing to prolong her life. This case exemplifies the burden placed on judges called on to decide a legal issue which also has a profound moral dimension. Medical science and the means of health case have nearly doubled life expectancy in the last fifty years. Yet, along with increased longevity and the j wonders of modern medicine, new j problems, legal and ethical, have been created. For example, the body can now j be kept 'alive' long after the brain is dead. j j j The ward in this case is now a woman in her mid-forties, who some twenty- three years ago suffered very serious brain damage in the course of what should have been a routine gynaecological operation. Since then, she has been near-PVS in an Irish hospital, where she has been kept

alive only by means of a life support feeding system.

terminated or death accelerated). The Court decided that the ward's personal rights were not lessened or diminished by her incapacity and that the responsibility for their exercise and vindication rested with the Court (rather than the next of kin) to make the decision, with the first and paramount consideration being the well-being, welfare and interests of the ward. The Supreme Court majority accepted that the true cause of death in the event of withdrawal of nourishment would be the original injuries sustained. The Supreme Court decision, even though grounded on the Irish Constitution, gave consideration to precedents from the other common law jurisdictions where the issue of withdrawal of a life-support feeding system had been addressed. It appears that such decisions in those other jurisdictions have not resulted in a flood of court applications. In the UK, only five similar applications have been made since the 1992 House of Lords judgment in the Bland case. The Supreme Court (following the Bland judgment and a number of the American judgments) decided that the use of a gastrotomy tube for feeding purposes constituted "medical

This is the first time that the Irish courts have had to decide the issue of whether it is lawful to withdraw a life support feeding system from a patient, which would, as a consequence, result in the patient's death. Issues relating to the discontinuance of tube-feeding or the turning-off of ventilators have been judicially considered in the USA (in some 9 0 court applications in 24 states) since being first considered in the high profile Karen Quinlan case in 1976. Most of those court applications in the US have been granted and similar applications have been granted by courts in Canada, New Zealand, Australia and South Africa. In the United Kingdom, in November 1992, the House of Lords unanimously held that it was lawful to withdraw the life support feeding system of Anthony Bland, a long unconscious victim of the Hillsborough football stadium disaster. In its deliberations, the Supreme Court considered whether the personal rights protected by the Constitution would include the right to refuse medical care or treatment and whether the right to life included the right to die a natural death (as opposed to having life

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