When is it in a patient’s best interests to withhold or withdraw life-sustaining treatment?

When is it in a person's best interests to withhold or withdraw life-sustaining treatment?

The landmark English case of Airedale NHS Trust v Bland provides an example of when it might be in a person’s best interests to withhold or withdraw life-sustaining treatment.

Bland was a 17 year old man who was injured in the Hillsborough disaster when he was crushed in a football stadium. His brain was deprived of oxygen which resulted in a permanent, catastrophic injury. He was diagnosed as being in a persistent vegetative state (post-coma unresponsiveness). As a result he could not see, hear or feel anything, could not communicate, and did not have any cognitive function. However, his heart kept beating and he was able to breathe and undertake digestion.

Bland was kept alive by artificial nutrition and hydration for over three years before the hospital authority (with the support of his treating doctors and family) approached the Court for declarations that the ongoing medical treatment cease, except treatment needed to make him comfortable. If the declarations were granted, Bland would die.

In relation to best interests, the Court decided that "a doctor only owes a duty to provide treatment to a patient if it is in his or her best interests. Treatment that is futile cannot be in a patient’s best interests, and doctors do not have a duty to provide that treatment. In those cases, the withholding and withdrawing of treatment is lawful".

The Court concluded that there can be situations where providing life-sustaining treatment will no longer be in a person's best interests. In the case of Bland, the Court said it is not appropriate to prolong a person's life when the treatment has no therapeutic purpose, such as where it is futile because the person is unconscious and has no chance of improving.

This case illustrates that a person's health professionals are able to withhold or withdraw treatment that does not benefit the person, or is not in his or her best interests.

Some Australian cases have also considered the issue of best interests. See for example Messiha v South East Health and Northridge v Central Sydney Area Health Service. Some observations from these cases are:

• That it is not in a person’s best interests to receive treatment that is futile.

• In deciding what is in a person's best interests, the courts will consider the extent to which the treatment is burdensome or intrusive, or whether it would be causing the person unwarranted pain or indignity.