Report No. 196
Lord Browne Wilkinson observed:
"Faced with this problem, the House of Lords in In re F. (1990) (2) A.C. page 1, developed and laid down a principle, based on concepts of necessity, under which a doctor can lawfully treat a patient who cannot consent to such treatment if it is in the interests of the patient to receive such treatment. In my view, the correct answer to the present case depends on the extent of the right to continue lawfully to invade the bodily integrity of Anthony Bland without his consent. If, in the circumstances, they have no right to continue artificial feeding, they cannot be in breach of any duty, by ceasing to provide such feeding."
While accepting the procedure of obtaining a declaration from Court, he says:
"(In re F), both Lord Brandon of Oakbrook (at p.64) and Lord Goff (at p.75, 77) make it clear that the right to administer invasive medical care is wholly dependent upon such care being in the "best interests" of the patient. Moreover, a doctor's decision whether invasive care is in the best interests of the patient falls to the assessed by reference to the test laid down in Bolam v. Frienn Hospital Management Committee, 1957 (1) WLR 582, viz., is the decision in accordance with a practice accepted at the time by a responsible body of medical opinion."
On the basis of that test, Lord Browne-Wilkinson concludes that "if there comes a stage where the responsible doctor comes to the reasonable conclusion (which accords with the views of a responsible body of medical opinion), that further continuance of an intrusive life support system is not in the "best interests" of the patient, he can no longer lawfully continue that life support system; to do so would constitute the crime of battery and the tort of trespass to the person. Therefore, he cannot be in breach of any duty to maintain the patient's life. Therefore, he is not guilty of murder by omission."
The above judgment of the House of Lords in Airedale lays down a crucial principle of law when it says that withholding or withdrawal of life support to a dying patient merely amounts to allowing the patient to die a natural death and that where death in the normal course is certain, withholding or withdrawal of life support is not an offence.
If a patient capable of giving informed consent refuses to give consent or has, in advance, refused such consent, the doctor cannot administer life support systems to continue his life even if the doctor thinks that it is in the patient's interest to administer such system. The patient's right of self-determination is absolute. But the duty of a doctor to save life of a patient is not absolute. He can desist from prolonging life by artificial means if it is in the best interests of the patient. Such an omission is not an offence. The doctor or the hospital may seek a declaration from the Court that such withholding, which is proposed, will be lawful.
In this Chapter, we have set out the broad principles laid down by the House of Lords in Airedale. In the next Chapter, we shall refer to other cases decided in UK before and after Airedale.