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The papers in this special issue consider important legal, ethical, clinical and practical implications of decisions to withdraw clinically assisted nutrition and hydration (CANH) from patients who are either in a persistent vegetative state (PVS) or a minimally conscious state (MCS). They grapple with a range of difficult questions that decisions of this kind raise. For a start, what are PVS and MCS and is it possible to categorise (or categorise definitively) a patient as falling within one rather than another category? Even if this is possible, is it useful (clinically) or necessary (legally) to do so? What is the law that governs how we should treat such patients? What is meant by the term ‘best interests’ in the context of withdrawal of CANH? And who should be charged with making the decision about withdrawing this treatment?
These are challenging questions and this special edition of the journal draws on interdisciplinary expertise from leading scholars and practitioners in their field to shed light on how they should be answered. The authors include an experienced Court of Protection judge who has helped shape the law in this field, a practising lawyer, a philosopher, ethicists, sociologists and clinicians including those working in the field of rehabilitation and treatment of patients in PVS or MCS.
What does the law require?
A threshold question is whether court approval is required when a treating team and the patient’s family wish to withdraw CANH. This is a simple question and should have a simple answer. Yet, as is evident in the papers that follow, there are different views on this. The special edition contains the transcript of the Oxford Shrieval Lecture delivered by Mr Justice Baker in 2016 entitled ‘A matter of life and death’. Justice Baker has presided over cases of this kind and is of the view that the court …
Competing interests None declared.
Provenance and peer review Commissioned; internally peer reviewed.