David James - Court Denies Hospital Permission to Stop Life-SustainingTreatment

In May, 68-year-old former
musician David James was admitted to a
British hospital with constipation.  But he went on to develop pneumonia
and became critically unwell.  He has had
a stroke, resulting in damage to the brain and loss of function on his right
side, and he has also had a number of cardiac arrests and suffered kidney
damage.  Clinicians have diagnosed him as in a minimally conscious state.

More recently, the hospital applied to the Court of Protection for
a declaration that, if James’ condition deteriorated, it need
not offer him “futile and burdensome” treatment
(cardiopulmonary resuscitation, renal replacement treatment, or invasive
support for chronic low blood pressure). 

Mr. Justice Peter Jackson refused the hospital's declaration, stating:
 “Although Mr. James’s condition is in many

respects grim, I am not persuaded that treatment would be
futile or overly burdensome or that there is no prospect of recovery.”
 “Although the burdens of treatment are very great indeed, they have
to be weighed against the benefits of a continued existence.”  He added that recovery did not mean a return
to full health but the resumption of a quality of life that James himself would consider worthwhile.

Justice Jackson further observed that doctors had undervalued
the limited quality of life that the patient could still enjoy. He also
noted that James’s medical condition was “fluctuating,” adding that it
would not be right to validate in advance the withholding of the
treatments in all circumstances.  (Liverpool
Daily Trust) (BMJ 2012; 345: e8404)

This case is not surprising.  Many cases (famously Wendland and Martin in the USA, for example) have drawn a sharp distinction between PVS and MCS patients.  Clinicians can usually establish zero quality of life, and thus best interest, to stop LSMT for a PVS patient.  But it is far tougher to do that for an MCS patient.  Even British cases have denied clinician requests to stop LSMT in which severely brain damaged children would still interact with her environment, for example, by smiling at their parents.