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KembaraXtra-Case Law-Airedale NHS Trust v Bland (1993)
Core Principle
Withdrawal of treatment = Omission, not a positive act: Discontinuing life support is legally viewed as an omission (failing to act) rather than a positive act (taking action to cause death).
Key Points from Lord Goff
Discontinuing Life Support vs. Not Initiating: Lord Goff argues there's no significant difference between stopping life support and never starting it in the first place.
Allowing to Die: The doctor is "allowing his patient to die" by not taking steps to prevent death from the pre-existing condition.
Omission & Duty: An omission is only unlawful if it violates a duty of care to the patient.
Artificial Nutrition & Hydration
Specific to Artificial Means: The ruling applies only to artificial feeding and hydration methods (nasogastric tubes, IVs, feeding tubes directly into the stomach). It does not apply to oral feeding and hydration.
Medical Treatment: Artificial nutrition and hydration are considered medical treatment.
Best Interests: This treatment can be withheld or withdrawn if it's not in the patient's best interests.
Lord Keith's Statement
Holistic View: The entire medical regime, including artificial feeding, should be considered.
Medical Technique: Administering nourishment via artificial means is a medical technique.
Practical Implications & Guidelines
Court Approval: The House of Lords recommended seeking court approval before withdrawing artificial feeding and nutrition from patients in a vegetative state.
Official Solicitor's Practice Note: This recommendation is formalized in the Official Solicitor’s Practice Note, "Declaratory Proceedings: Medical and Welfare Decisions for Adults who Lack Capacity" (May 2001).
Key Takeaways
Bland establishes a crucial distinction between omission and positive act in medical treatment withdrawal.
It specifically addresses artificial nutrition and hydration as a form of medical treatment subject to the patient's best interests.
The case emphasizes the need for legal oversight and court approval in cases involving withdrawing artificial feeding from patients in a vegetative state.
Core Principle
Withdrawal of treatment = Omission, not a positive act: Discontinuing life support is legally viewed as an omission (failing to act) rather than a positive act (taking action to cause death).
Key Points from Lord Goff
Discontinuing Life Support vs. Not Initiating: Lord Goff argues there's no significant difference between stopping life support and never starting it in the first place.
Allowing to Die: The doctor is "allowing his patient to die" by not taking steps to prevent death from the pre-existing condition.
Omission & Duty: An omission is only unlawful if it violates a duty of care to the patient.
Artificial Nutrition & Hydration
Specific to Artificial Means: The ruling applies only to artificial feeding and hydration methods (nasogastric tubes, IVs, feeding tubes directly into the stomach). It does not apply to oral feeding and hydration.
Medical Treatment: Artificial nutrition and hydration are considered medical treatment.
Best Interests: This treatment can be withheld or withdrawn if it's not in the patient's best interests.
Lord Keith's Statement
Holistic View: The entire medical regime, including artificial feeding, should be considered.
Medical Technique: Administering nourishment via artificial means is a medical technique.
Practical Implications & Guidelines
Court Approval: The House of Lords recommended seeking court approval before withdrawing artificial feeding and nutrition from patients in a vegetative state.
Official Solicitor's Practice Note: This recommendation is formalized in the Official Solicitor’s Practice Note, "Declaratory Proceedings: Medical and Welfare Decisions for Adults who Lack Capacity" (May 2001).
Key Takeaways
Bland establishes a crucial distinction between omission and positive act in medical treatment withdrawal.
It specifically addresses artificial nutrition and hydration as a form of medical treatment subject to the patient's best interests.
The case emphasizes the need for legal oversight and court approval in cases involving withdrawing artificial feeding from patients in a vegetative state.
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