Report No. 196
Quality of life:
Proposition (iv) and (v) were taken up by Ward LJ in the context of Mary. Would Mary's life, if not separated from his twin, "be worth nothing to her"? 'Quality of life' that would continue after surgery was treated as relevant in Re B in 1981: 1981(1) WLR 1424 where Templeman & Dunn LJJ referred to it. The former said the test to be adopted was
"whether the life of this child is demonstrably going to be so awful that in effect the child must be condemned to die."
After referring to the above, Ward L J quoted the case decided by him in In Re C (A Minor) (Wardship: Medical Treatment)(dt. 14.4.89) 1990 Fam 26 (on appeal see Re C: 1989(2) All ER 782, dt. 20.4.89) where he approached the question as follows: firstly that no treatment would alter the hopelessness of the child's position and secondly, that in so far as he was able to assess the quality of life "which as a test in itself raises as many questions as it can answer". He judged the quality of the child's life as demonstrably "awful and intolerable", following Re B.
Similarly in Re J (A minor)(Wardship: Medical Treatment): 1990 (3) All ER 930 (CA), the Court of Appeal rejected the Official Solicitor's submission and stated that 'life would be intolerable to the child judged from the perspective of the child'.
After referring to the views of academics and others and to the 'right to life', Ward LJ said that he would not agree that 'Mary's life would be worth nothing to her'. Her life had its own "eneliminable" value and dignity.
Next question is whether "To prolong Mary's life.. would be very seriously to her disadvantage?" But as the proposed treatment would not prolong her life, this question does not arise. According to Lord Goff in Airedale, the decision to discontinue a line of treatment which prolongs life is governed by the principle of the patient's best interests.
In the present case, the treatment amounts to an invasion and Mary's consent is necessary. Mary is not receiving treatment and there is also no question of discontinuing a treatment.
Hence, the proposed surgery is not in Mary's interests according to Ward LJ. But, this conclusion was not end of the judgment of Ward LJ. He posed further questions.
