Airedale NHS Trust v Bland [1993] AC 789

Key point

  • While euthanasia is unlawful as it is a positive act that amounts to murder, removal of life support is lawful as it is an omission

Facts

  • Tony Bland was a persistent vegetative state and had no hope of recovery
  • Hospital with parents applied for a declaration that it might lawfully discontinue life sustaining treatment and life support
  • Official solicitor appealed against Court of Appeal order permitting it

Held (House of Lords)

  • Removal of life support is permitted as it did not amount to murder
  • The actus reus of actively causing death would not be present

Lord Goff

  • ‘The law draws a crucial distinction between cases in which a doctor decides not to provide, or to continue to provide, for his patient treatment or care which could or might prolong his life, and those in which he decides, for example by administering a lethal drug, actively to bring his patient’s life to an end’
  • ‘So to act is to cross the Rubicon which runs between on the one hand the care of the living patient and on the other hand euthanasia—actively causing his death to avoid or to end his suffering. Euthanasia is not lawful at common law.’
  • There was no duty to act either as treatment was not in the best interest of patient, there being no prospect of recovery

Lord Mustill

  • ‘I must recognise at once that this chain of reasoning makes an unpromising start by transferring the morally and intellectually dubious distinction between acts and omissions into a context where the ethical foundations of the law are already open to question’

Lord Browne-Wilkinson

  • ‘How can it be lawful to allow a patient to die slowly, though painlessly, over a period of weeks from lack of food but unlawful to produce his immediate death by a lethal injection, thereby saving his family from yet another ordeal to add to the tragedy that has already struck them? I find it difficult to find a moral answer to that question. But it is undoubtedly the law and nothing I have said casts doubt on the proposition that the doing of a positive act with the intention of ending life is and remains murder.’

Commentary

  • One problem with the analysis is that withdrawal of support would require active steps to removal the life support systems from the patient, thus it is an omission only in a legal and not physical sense
  • The analysis in the judgment is based on a very fine and shaky distinction between acts and omissions, and Lord Mustill and Lord Browne-Wilkinson expressed concerns about settling the difficult ethical questions raised on this basis

 

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