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Withdrawing treatment from patients with prolonged disorders of consciousness: the presumption in favour of the maintenance of life is legally robust
  1. Charles Foster1,2
  1. 1 Faculty of Law, University of Oxford, Oxford, Oxfordshire, UK
  2. 2 Green Templeton College, University of Oxford, Oxford, UK
  1. Correspondence to Professor Charles Foster, Faculty of Law, University of Oxford, Oxford OX1 3UL, UK; Charles.Foster{at}


The question a judge has to ask in deciding whether or not life-sustaining treatment should be withdrawn is whether the continued treatment is lawful. It will be lawful if it is in the patient’s best interests. Identifying this question gives no guidance about how to approach the assessment of best interests. It merely identifies the judge’s job. The presumption in favour of the maintenance of life is part of the job that follows the identification of the question.

The presumption is best regarded as a presumption of law. It has long been recognised as part of the way in which the English law discharges its obligations under Article 2 of the European Convention on Human Rights (the right to life). But even if it is a ‘mere’ evidential presumption it cannot, on the facts of most cases involving applications for the withdrawal of life-sustaining treatment from patients in prolonged disorders of consciousness, be rebutted.

  • decision-making
  • end-of-life
  • law
  • prolongation of life and euthanasia

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  • Contributors I am the sole author of this article.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Patient consent for publication Not required.

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

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