THE line between life and death was redrawn yesterday when the High Court ruled that doctors will only have the right to withdraw treatment from patients if their lives have become intolerable.

The ruling will have far-reaching implications for all those who may one day rely on medical treatment such as artificial feeding to keep them alive. Until now doctors have had broad powers to withdraw treatment based on their perception of a patients quality of life. In future that test will signifincantly tougher.

“These issues are quite literally matters of life and death,” said Mr Justice Mumby. “They are issues which potentially affect us all. For all of us must die and any of us may at some time need artificial nutrition and hydration”.

The ruling came in a case brought by a terminally ill man with a degenerative condition, who argued that it should be for him, and not his doctors, to decide whether to withdraw artificial feeding from him after he is unable to move or speak.

Leslie Burke, 44, a former postman from Lancaster who brought the case, said yesterday that he was “walking on air” after receiving the judgement, which will effectively allow him to chose the manner of his death. “It just seems like a great weight lifted off my shoulders,” he said.

The ruling means that General Medical Council (GMC) guidelines for doctors on withdrawing artificial nutrition and hydration (ANH) will now have to be redrawn. Under the current guidance, doctors currently make decisions on whether to withdraw life-sustaining treatment based on their assessment on the patient’s “quality of life”.

The ruling will replace this “quality of life” test with a tougher “intolerability” test.

“If life-prolonging treatment is providing some benefit it should be provided unless the patient’s life, if thus prolonged, would from the patient’s point of view, be intolerable,” the judgement states.

If there remains any doubt in the matter, the judgement adds, it should be “resolved in favour of the preservation of life”.

The ruling also means that doctors must fulfil a patient’s wishes to have life-prolonging treatment, where those wishes have been expressed. If patients have not made a “living will” of their preferences for treatment and are unable to express an opinion because of his or her illness, doctors must presume that treatment should be given and then apply the “intolerability” test.

In a move that will also shift the decision making firmly towards the courts and away from doctors, the judgement adds that if there is a lack of consensus by medical professionals about treatment being withheld or withdrawn and the patient’s best interests, such decisions must now be authorised by the courts.

Decisions should also be referred to court if there is a dispute between any of the medical professionals and relatives or carers as to whether artificial feeding should be ceased or withheld.

Paul Conrathe, of Ormerods Solicitors, Croydon, who acted for Mr Burke, said that the judgement effectively meant that parts of the GMC guidance were unlawful. “The guidance failed to emphasise adequately the heavy presumption in law of life prolonging treatment. Crucially the patient’s request for such treatment was not just a factor to be taken into account when the doctor made the decision. The request had to be acted upon,” he said.

The GMC said it would appeal against the judgement. In a statement it noted that the judgement made clear that doctors were not obliged to provide treatment that is futile, or places an intolerable burden on the patient. “It is our stated position that in cases where there is disagreement over the care of a patient, the courts should be approached for a ruling,” it said.

Bert Massie of the Disability Rights Commission, which joined Mr Burke’s case, welcomed the ruling, adding that the existing “quality of life” test applied by doctors had been deeply flawed.

He said doctors’ opinions could be based on a backdrop of negative images and poorly informed assumptions of what it was like to be disabled, leading to a false view that a particular disability makes life not worth living, he said.

“This judgement provides genuine protection for disabled people with serious long-term conditions. They want health professionals to do as much as possible to preserve life — as they would do for non-disabled people.”

Dr Michael Wilks, chair of the British Medical Association’s Medical Ethics Committee, said: “The BMA believes that people should talk to relatives and others close to them about their wishes in the event of serious illness and decisions about life-prolonging treatments.”

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