would not allow him to do so till Saturday 31 December. He did not tell the receptionist at the surgery of the full circumstances of the illness and the doctor did not come. In the afternoon of the same day S phoned again. A locum called, but the deceased died of puerperal fever before he arrived. Medical evidence was that she could have been saved had a doctor been called before that Saturday. S was charged with (1) manslaughter of his wife on 31 December; (2) concealment of birth on 28 December. On the second count his defence was that they did not intend to conceal the birth permanently but would have told the police when they felt up to it. The judge directed the jury that this amounted to a defence to the charge. The judge in his summing-up directed that it had to be proved that in reckless disregard of his duty to care for the deceased’s health, S failed to get medical attention, and that as a direct result of that failure she died. ‘Reckless disregard’ meant that, fully appreciating that she was so ill that there was a real risk to her health if she did not get help, S did not do so, either because he was indifferent, or because he deliberately ran a wholly unjustified and unreasonable risk. It was accepted that he was not indifferent – the evidence was that they were a devoted couple and that he stayed with her all the time when she was ill. It was also accepted that she did not want a doctor called, and the jury had to balance the weight that it was right to give to this wish against her capacity to make rational decisions. In addition it had been proved that the ‘reckless disregard’ led to the death and that had S acted differently on 31 December, his wife’s life would have been saved. The jury convicted on the second count but could not agree on the charge of manslaughter and were discharged from giving a verdict. Airedale National Health Service Trust v Bland [1993] 1 All ER 82 (HL) Anthony Bland was injured in the Hillsborough Stadium disaster. He suffered irreversible brain damage and was diagnosed as being in a persistent vegetative state (PVS). Expert medical evidence was to the effect that there was no hope of recovery. The Airedale NHS Trust, with the support of Bland’s parents, sought a declaration that the doctors treating Bland might lawfully discontinue all life-sustaining treatment and medical treatment except that required to enable Bland to die without unnecessary distress. The Official Solicitor appealed to the House of Lords against the granting of the declaration on the basis that the withdrawal of life support treatment would amount to murder.

DOI link for would not allow him to do so till Saturday 31 December. He did not tell the receptionist at the surgery of the full circumstances of the illness and the doctor did not come. In the afternoon of the same day S phoned again. A locum called, but the deceased died of puerperal fever before he arrived. Medical evidence was that she could have been saved had a doctor been called before that Saturday. S was charged with (1) manslaughter of his wife on 31 December; (2) concealment of birth on 28 December. On the second count his defence was that they did not intend to conceal the birth permanently but would have told the police when they felt up to it. The judge directed the jury that this amounted to a defence to the charge. The judge in his summing-up directed that it had to be proved that in reckless disregard of his duty to care for the deceased’s health, S failed to get medical attention, and that as a direct result of that failure she died. ‘Reckless disregard’ meant that, fully appreciating that she was so ill that there was a real risk to her health if she did not get help, S did not do so, either because he was indifferent, or because he deliberately ran a wholly unjustified and unreasonable risk. It was accepted that he was not indifferent – the evidence was that they were a devoted couple and that he stayed with her all the time when she was ill. It was also accepted that she did not want a doctor called, and the jury had to balance the weight that it was right to give to this wish against her capacity to make rational decisions. In addition it had been proved that the ‘reckless disregard’ led to the death and that had S acted differently on 31 December, his wife’s life would have been saved. The jury convicted on the second count but could not agree on the charge of manslaughter and were discharged from giving a verdict. Airedale National Health Service Trust v Bland [1993] 1 All ER 82 (HL) Anthony Bland was injured in the Hillsborough Stadium disaster. He suffered irreversible brain damage and was diagnosed as being in a persistent vegetative state (PVS). Expert medical evidence was to the effect that there was no hope of recovery. The Airedale NHS Trust, with the support of Bland’s parents, sought a declaration that the doctors treating Bland might lawfully discontinue all life-sustaining treatment and medical treatment except that required to enable Bland to die without unnecessary distress. The Official Solicitor appealed to the House of Lords against the granting of the declaration on the basis that the withdrawal of life support treatment would amount to murder.

ABSTRACT

Lord Goff: I agree that the doctor’s conduct in discontinuing life support can properly be categorised as an omission It is true that it may be difficult to describe what the doctor actually, does as an omission, for example where he takes some positive step to bring the life support to an end. But discontinuation of life support is, for present purposes, no different from not initiating life support in the first place. in each case, the doctor is simply allowing his patient to die in the sense that lie is desisting from taking a step which might, in certain circumstances, prevent his patient front dying as a result of his pre-existing condition: and as a matter of

general principle an omission such as this will not be unlawful unless it constitutes a breach of duty to the patient. I also agree that the doctor’s conduct is to be differentiated from that of, for example, an interloper who maliciously switches off a life support machine because, although the interloper may perform exactly the same act as the doctor who discontinues life support, his doing so constitutes interference with the life-prolonging treatment then being administered by the doctor. Accordingly, whereas the doctor, in discontinuing life support, is simply allowing his patient to die of his pre-existing condition, the interloper is actively intervening to stop the doctor from prolonging the patient’s life, and such conduct cannot possibly he categorised as an omission …If the justification for treating a patient who lacks tile capacity to consent lies in the fact that the treatment is provided in his best interests, it must follow that the treatment may, and indeed ultimately should, be discontinued where it is no longer in his best interests to provide it. The question which lies at the heart of the present case is, as I see it, whether on that principle the doctors responsible for the treatment and care of Anthony Bland can justifiably discontinue the process of artificial feeding upon which the prolongation of his life depends.