title: Judicial oversight of life-ending withdrawal of assisted nutrition and hydration in disorders of consciousness in the United Kingdom: A matter of life and death.
abstract: Mr Justice Baker delivered the Oxford Shrieval Lecture 'A Matter of Life and Death' on 11 October 2016. The lecture created public controversies about who can authorise withdrawal of assisted nutrition and hydration (ANH) in disorders of consciousness (DOC). The law requires court permission in 'best interests' decisions before ANH withdrawal only in permanent vegetative state and minimally conscious state. Some clinicians favour abandoning the need for court approval on the basis that clinicians are already empowered to withdraw ANH in other common conditions of DOC (e.g. coma, neurological disorders, etc.) based on their best interests assessment without court oversight. We set out a rationale in support of court oversight of best interests decisions in ANH withdrawal intended to end life in any person with DOC (who will lack relevant decision-making capacity). This ensures the safety of the general public and the protection of vulnerable disabled persons in society.
authors.affiliation: 1 Mayo Clinic College of Medicine and Science and Department of Critical Care Medicine, Mayo Clinic Hospital, Phoenix, AZ, USA.
authors.forename: Mohamed Y
authors.initials: MY
authors.lastname: Rady
authors.affiliation: 2 Scottsdale, AZ, USA.
authors.forename: Joseph L
authors.initials: JL
authors.lastname: Verheijde
mesh_terms: D003657:Decision Making; D004750:Enteral Nutrition / Q000379:methods*; D006801:Humans; D033222:Judicial Role; D018458:Persistent Vegetative State / Q000150:complications / Q000628:therapy*; D006113:United Kingdom; D028761:Withholding Treatment / Q000331:legislation & jurisprudence*
keywords: Decision-making; disorders of consciousness; end-of-life care; ethics; hydration; law; neuroscience; nutrition; treatment withdrawal