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Friday, 22 March, 2002, 11:19 GMT
Q&A: Right-to-die decision

A 43-year-old paralysed woman has the right to ask for her life support machine to be turned off, the High Court has decided.

The woman, known only as "Miss B" can now move to another hospital where doctors are prepared to allow her to die.

BBC News Online examines the case, and what it means for other patients.

What exactly has been decided here?

Consent is an important principle in the relationship between patient and doctor.

In normal circumstances, no treatment or operation can be given without the fully informed consent of the patient involved.

Any patient has the legal right to refuse treatment, unless it can be proved that they lack the mental capacity to make such a decision.

In such circumstances, doctors can make the decision to treat them without their consent.

The case here revolved around whether "Miss B" had the mental capacity to make her decision to refuse treatment.

The treatment in her case involved her use of a mechanical ventilator to keep her breathing - a life support machine.

Dame Elizabeth Butler Sloss ruled that she was indeed mentally competent to make the decision.

Why is the case unique?

There have been other cases in which judges have been asked about withdrawing "treatment" from patients.

The most famous is the Tony Bland case in 1993, in which the House of Lords ruled that artificial feeding could be withdrawn from a teenager in a "persistent vegetative state" - a coma-like condition with no hope of recovery.

In that case, arguments centred on whether feeding and water constituted "treatment".

However, what makes "Miss B" different is that she is conscious, in a stable condition - with the potential to live for decades before dying.

In addition, there is no argument over the nature of the treatment she wants to stop - the ventilator.

Doctors believed that, with rehabilitation, her quality of life could be improved, although she is adamant this is not what she wants.

Ultimately...the patient's view must be respected

BMA guidance on refusal of treatment
There are likely to have been many similar cases in which patients have asked for ventilation to be withdrawn - but in these, doctors, after careful discussion, have followed the wishes of the patient.

The insistence of the medical team and the trust in taking the issue to court is what marks out this case as unusual.

The ruling reaffirms the right of patients to make rational decisions about their future care - and the fact that doctors have only limited rights to overrule them.

Do doctors have guidelines to follow about issues such as these?

They do. The British Medical Association has issued advice to its members about this issue.

It is clear: "Where adult patients refuse procedures which are likely to benefit them, the BMA advises health professionals to provide information in a sensitive manner about the implications and explore with the patient whether relevant alternative options would be acceptable to the patient.

"Ultimately, however, the patient's view must be respected."

The Medical Defence Union, which advises doctors on legal issues, said: "Our members often ask for our advice on their position if a patient decides that they do not wish to continue with treatment which is keeping them alive.

"We advise any doctor in this difficult situation that a mentally competent adult patient has an absolute right to refuse medical treatment for any reason, rational or irrational and this ruling upholds this right. "

What does this mean for the future?

The progress of this case through the courts will make the issue clear to doctors facing the same situation with patients.

What it is likely to mean is that these cases continue to be handled locally, with doctors and patients making decisions together after consultation.

However, doctors can now be surefooted about what to do if the patient is "mentally competent" to make a decision.

There may still be cases in which doctors take recourse to the courts if they feel the patient is not competent - perhaps suffering from a mental illness which is clouding their ability to make a decision.

Those will be dealt with on a case by case basis.

Overall, the case will be viewed as another example of patients wresting back control of their own treatment from doctors.

It has no direct bearing on euthanasia or assisted suicide cases - where a doctor or another is actively helping a patient to die.

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