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06/08/2014

UK Court of Protection – Model for End-of-Life Treatment Dispute Resolution in USA

What can the United States learn from British jurisprudence on end-of-life treatment conflicts?  


Two things.  First, the Court of Protection regularly authorizes clinicians to withhold or withdraw life-sustaining interventions in a certain range of clinical circumstances.  For example, this week, Mr Justice Mostyn said it would be lawful for doctors not to resuscitate a man if he suffered a “cardio-respiratory arrest” and lawful not to treat him with antibiotics if he developed an “overwhelming infection.”  The man had suffered a significant brain injury and was in a persistent vegetative state. (Jersey Evening Post)  



Indeed, if one collects and reviews Court of Protection opinions from the past few years, one may discern a bright-line rule:  withholding critical care for PVS patients is appropriate.  (Less settled is whether ongoing critical care like ventilation and CANH can be withheld.)



Second, the very fact that these cases go to the Court of Protection means there is independent oversight.  In the United States (e.g. in Texas), these cases are often resolved by healthcare ethics committees comprised primarily or entirely of hospital insiders.  Such decision makers are hardly as neutral as a court.

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