Parishil Patel has today secured a landmark decision allowing a woman in a minimally conscious state to die.
This is the first case in which the judge (who has granted the application made by Parishil’s client, the patient’s daughter) has concluded that a person in a minimally conscious state (i.e. some limited awareness but not full awareness) can have clinically assisted nutrition and hydration withdrawn causing them to die. Previously the courts have only allowed people in a permanent vegetative state (i.e. those entirely lacking awareness) to have clinically provided food and water to be withdrawn.
It is therefore a huge step forward in the law of patient autonomy.
The judge concluded in this case that the right to life (although fundamental) is not absolute and, therefore, where a patient has made clear her wishes and feelings (although not in a formal living will), those wishes and feelings (as an expression of the patient’s autonomy) can outweigh the right to life and it is therefore in her best interests to be allowed to die. At present, she is being kept alive by artificial hydration and nutrition.
From a legal perspective, the interest in the case (apart from being the first case) is the extent to which a incapacitated person’s autonomy (in the expression of their past wishes and feelings, beliefs and value) must be reflected in their best interests. Just because, objectively, people may judge the decision (to allow her to die) as not being in the person’s best interests is irrelevant if , in the context of this individual’s character and personality, it is what she would clearly have wanted and therefore is in her best interests. Reflecting an incapacitated person’s autonomy strongly in the decision as to what is in his or her best interests ensures, as far as is possible, that they are not discriminated against by reason of their disability.
Parishil was instructed by Irwin Mitchell.
Vikram Sachdeva QC was acting for the Third Respondent, a Care Home.