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Withdrawing clinically assisted nutrition and hydration (CANH) in patients with prolonged disorders of consciousness: is there still a role for the courts?
  1. Veronica English,
  2. Julian C Sheather
  1. Department of Medical Ethics, British Medical Association, London, UK
  1. Correspondence to Dr Julian C Sheather, Department of Medical Ethics, British Medical Association, WC1H 9JP London, UK; jsheather{at}


Currently, in England and Wales, Court of Protection’s Practice Directive 9E (PD9E) requires all cases of proposed withdrawal or withholding of life-sustaining treatment in relation to adults in a permanent vegetative state (PVS) or minimally conscious state be referred to the Court. This paper looks at the origins of PD9E and contrasts the routine requirement to refer cases to court with the complex clinical terrain that comprises those suffering from prolonged disorders of consciousness. We look at the role of the court in decision making in these contexts and we ask what role the courts are called on to play in these decisions. We argue that PD9E, as currently drafted, is too imprecise to achieve its purpose. With our focus always on the best interests of patients, we argue that most decisions of this nature should be made according to a strict protocol but without the need for court approval. Court overview should be reserved for cases of disagreement between those involved in the decision that cannot be resolved by other methods, where there are serious doubts about the individual’s best interests or where there are legally untested aspects to the decision.

  • Ethics
  • Ethics committees/consultation
  • Clinical ethics
  • Capacity
  • End-of-life

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  • Contributors This paper was jointly written by the two authors. There are no other contributors to this article.

  • Competing interests None declared.

  • Provenance and peer review Commissioned; internally peer reviewed.

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