– Treatment had no positive effect, high court told

– Ruling allows NHS trust to withdraw medical support

David Pallister

Thursday December 7, 2006

The Guardian

A 53-year-old woman in a permanent vegetative state (PVS) can be allowed to die with dignity, a high court judge ruled yesterday. The woman, known as J, was given a miracle drug that might have restored consciousness against the fervent wishes of her family. Giving permission to an NHS trust to withdraw life-sustaining treatment, Sir Mark Potter, the president of the court’s family division, said the brief course of treatment with the drug zolpidem had produced no positive effect.

Although the court has sanctioned the withdrawal of sustenance from dozens of PVS patients since the 1993 case of Tony Bland, the 21-year-old brain-damaged survivor of the 1989 Hillsborough football ground disaster, this was the first time the controversial use of zolpidem had come before the English courts.

Manufactured as a sleeping pill, it was discovered seven years ago by a South African GP to have the still unexplained effect of “waking up” patients for a short time each day. J’s husband, one of her two daughters and a brother were in court to hear the judgment.

In August 1993 J suffered a massive brain haemorrhage while on holiday with her family. She went into a coma, then into PVS. Since January 2004, she has been cared for round the clock in a nursing home. Three months ago the trust, which cannot be named for legal reasons, launched court proceedings seeking rulings that it would be lawful to discontinue and withhold life-sustaining treatment and medical support, including nutrition and hydration, in a way that ensured she suffered the least distress “and retains the greatest dignity until such time as her life comes to an end”.

Sir Mark said he would normally have granted the applications without hesitation. But two scientific research articles had been brought to the attention of the official solicitor, Laurence Oates, who represents the interests of patients who lack capacity.

One of them, co-authored by the South African GP, had given the trust’s expert, Keith Andrews,of the Royal Hospital for Neuro-disability in Putney, south-west London, “pause for thought”. Professor Andrews, said the judge, “gave the reason for his view that it would be in the best interests of J to have the treatment essentially as being that, while there was a very slim outside chance of any effect being achieved, it was important that any patient in this state should be given a chance to recover if there was any such chance, however remote”.

Mr Oates then applied to the court, unopposed by the trust, for a three-day trial of zolpidem. Despite protests by the family that this could be “unbearably cruel” if J did regain consciousness and realised her predicament, Sir Mark accepted Prof Andrew’s views that their fears were not well-founded.

The trial with the drug went ahead last month. “Prof Andrews’s opinion that it was unlikely to produce any positive effect has indeed proved justified.” Sir Mark said. “J was carefully watched for any response or sign of increased awareness. The drug produced no increased responsiveness and instead it appeared to make her fall asleep – that is to say, it had its normal intended effect, it being a form of sleeping pill marketed as effective in dealing with cases of insomnia.

“Having considered the results of the zolpidem treatment and, in the light of all the other evidence … the official solicitor now supports the claimant trust’s application for declarations to the effect sought and in particular that it is lawful, as being in J’s best interests, for life-sustaining treatment and medical support designed to keep her alive in her permanent vegetative state to be discontinued.”

The woman’s “devoted” family – her husband, their two daughters and her mother – “unanimously support that application”. Their view was that withdrawal of artificial nutrition and hydration was in her best interests and based on previous conversations with her, they were in no doubt she would not wish her life to be prolonged in her present condition.

Guardian