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  • When ‘Sanctity of Life’ and ‘Self-Determination’ clash: Briggs versus Briggs [2016] EWCOP 53 – implications for policy and practice

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Disorders of consciousness
When ‘Sanctity of Life’ and ‘Self-Determination’ clash: Briggs versus Briggs [2016] EWCOP 53 – implications for policy and practice
  1. Jenny Kitzinger1,
  2. Celia Kitzinger2,
  3. Jakki Cowley3
  1. 1 School of Journalism, Media and Cultural Studies, Cardiff University, Cardiff, UK
  2. 2 Department of Sociology, University of York, York, UK
  3. 3 Empowerment Matters, Liscard Business Centre, The Old School, Liscard, UK
  1. Correspondence to Professor Jenny Kitzinger, School of Journalism, Media and Cultural Studies, Cardiff University, Cardiff, Wales; kitzingerj{at}cardiff.ac.uk

Abstract

In a landmark judgment in the English Court of Protection, the judge (Charles J) found it to be in the best interests of a minimally conscious patient for clinically assisted nutrition and hydration (CANH) to be withdrawn, with the inevitable consequence that the patient would die. In making this judgment, it was accepted that the patient’s level of consciousness — if CANH were continued and rehabilitation provided — might improve, and that he might become capable of expressing emotions and making simple choices. The decision to withdraw treatment relied on a best interests decision, which gave great weight to the patient’s past wishes, feelings, values and beliefs, and brought a ‘holistic’ approach to understanding what this particular patient would have wanted. We draw on our own experience of supporting families, advocating for patients and training healthcare professionals in similar situations to consider the implications of the published judgment for policy and practice with patients in prolonged disorders of consciousness and their families.

  • Capacity
  • Prolongation of Life and Euthanasia
  • Quality/Value of Life/Personhood
  • Autonomy
  • Decision-making

This is an Open Access article distributed in accordance with the terms of the Creative Commons Attribution (CC BY 4.0) license, which permits others to distribute, remix, adapt and build upon this work, for commercial use, provided the original work is properly cited. See: http://creativecommons.org/licenses/by/4.0/

https://doi.org/10.1136/medethics-2016-104118

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    Footnotes

    • Contributors The article is the output of intense collaborative work and discussion between the three authors. An initial version of the article was written by CK and JK jointly, with revision and restructuring input from JC.

    • Funding Research Councils UK - Economic and Social Research Council, ES/M500574/1.

    • Competing interests All three authors regularly provide training about prolonged disorders of consciousness to health and social care professionals and to professionals involved in the work of the Court of Protection. The authors also provide informal support for families with relatives in disorders of consciousness (CK and JK) and JC is an independent patient advocate. The authors were involved with the family in the Briggs case in the year preceding the hearing (and subsequently), but have not drawn on any information other than that contained in the published judgment in this article. Additionally CK and JK have a sister who was severely brain-injured in a road traffic collision and was in a disorder of consciousness for about 2 years, surviving with profound neurological and physical disabilities. CK is Chair of a working party seeking to amend the Court of Protection's Practice Direction 9E concerning court applications for patients in prolonged disorders of consciousness. JK is a core editorial group member, and JC is a member, of the Royal College of Physicians working party, which authored the national guidelines for the management of prolonged disorders of consciousness.

    • Patient consent Patient was subject of public court hearing and all information was publicly available.

    • Provenance and peer review Not commissioned; externally peer reviewed.

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