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Published online by Cambridge University Press: 28 February 2024
The Hillsborough football disaster in 1989 left Tony Bland in what doctors call a ‘persistent vegetative state’ (‘PVS’). His heart still pumped, he breathed, and most of his other vital organs worked, all unassisted. His eyes opened and shut; he yawned and moved reflexively; he reacted to loud noises with a start. But as far as doctors could tell he could not perceive, think or feel, and would never regain consciousness in this life. The English High Court, the Court of Appeal and (last month) the House of Lords all ruled that all food, water and antibiotics might be withdrawn from Tony Bland and sedatives administered so that he would die peacefully and soon.
The judges were keenly aware of the moral, legal and social dilemmas which the case occasioned. In general they took the view that the law should closely reflect what is ‘morally right’ in such areas, or at least ‘what society accepts as morally right’. They thought there were three principles to be balanced and applied in this case; the sanctity of life; the autonomy of the patient; and the duty of care. The principle of the sanctity of human life was said to be deeply embedded in our law and ethics, in Britain and throughout the world, included in international human rights documents, and strongly felt by people of all religions and none.
1 Airedale NHS Trust v. Anthony Bland (by his guardian ad litem, The Official Solicitor of the Supreme Court): High Court of Justice (Family Division), [1993] 2 WLR 322 per Sir Stephen Brown P; 19 November 1992; Court of Appeal (Civil Division), [1993] 2 WLR 332 per Sir Thomas Bingham, MR, Butler‐Sloss and Hoffmann LJJ; House of Lords, [1993] 2 WLR 359 per Lords Keith, Goff, Lowry, Browne‐Wilkinson and Mustill. References to the Attorney‐General are to the 'Outline Submissions of the Amicus Curiae'.
2 Last year Bishop Christopher Budd of Plymouth said that feeding Tony Bland is the kind of basic care owed to every human being, not a form of “extraordinary care” which might properly be withheld (The Tablet, 28 November 1992). Many American bishops have repeatedly made similar statements. See also: Pontifical Academy of Sciences, The Artificial Prolongation of Life and the Exact Definition of the Moment of Death., 30 October 1985; Committee for Pro‐Life Activities of the US National Conference of Catholic Bishops, Guidelines for Legislation on Life‐Sustaining Treatment, 10 November 1984, and Statement on Uniform Rights of the Terminally III Act, June 1986; New Jersey Catholic Conference, Amicus curiae brief In the Matter of Nancy Ellen Jobes, October 1986.
3 Those regarding tube‐feeding as a medical treatment which can properly be withdrawn from the permanently comatose include: John Paris, S.J. & Richard McCormick, S.J., “The Catholic tradition on the use of nutrition and fluids,”America, 2 May 1987, 358; Richard McCormick, S.J., “Caring or starving? The case of Claire Conroy,”America, 6 April 1986; Edward Bayer, “Is food always obligatory?”Ethics & Medicine, 10 (1985); Kevin O'Rourke, O.P., “The AMA Statement on tube feeding: an ethical analysis,”America, 22 November 1986, 321–323, 331; Daniel Callahan, “On feeding the dying,”Hastings Center Report, 131(5) (Oct 1983). Barry, Robert O.P., Medical Ethics: Essays on Abortion and Euthanasia (New York: Peter Lang, 1989)Google Scholar provides a summary and critique of these authors. Those regarding tube‐feeding as a medical treatment or quasi‐medical treatment, but one which should normally be maintained for the comatose include: Connery, John S.J., “In the Matter of Clare Conroy,”Linacre Quarterly, 52 (Nov 1985), 321–334Google Scholar and “The ethics of withholding/withdrawing nutrition and hydration,”Linacre Quarterly, 54 (Feb 1987)Google Scholar; May, William E., “Feeding and hydrating the permanently unconscious and other vulnerable persons,”Issues in Law & Medicine, 3 (1987), 203–217Google ScholarPubMed and “Statement in support of the New Jersey Catholic Conference,” in Barry (1989), 263–272;Grisez, Germain, “Should nutrition and hydration be provided to permanently unconscious and other mentally disabled persons?”Linacre Quarterly, 57 (May 1990), 30–43CrossRefGoogle Scholar. Those opposed to regarding tube‐feeding as a medical treatment, who argue instead that it is part of the normal or minimum care due to all patients, include: Barry, Robert O.P., “Facing hard cases: the ethics of assisted deeding,”Issues in Law & Medicine, 2 (1986), 100–106Google Scholar, and “The ethics of providing life‐sustaining nutrition and fluids to incompetent patients,”Journal of Family & Culture, 1(2); Piccione, Joseph, “The tradition of care,”Euthanasia Review, 1 (2): 129–31Google Scholar; Smith, William, “Judaeo‐Christian teaching on euthanasia: definitions, distinctions and decisions,”Linacre Quarterly, 54 (Feb 1987)CrossRefGoogle Scholar.
4 Finnis, John & Fisher, Anthony O.P., “Theology and the four principles [of bioethics]: a Roman Catholic view,” in Gillon, Raanon (ed), Principles of Health Care Ethics (London: John Wiley & Sons, 1993)Google Scholar; Luke Gormally, “Against voluntary euthanasia,” in Gillon (1993); Linacre Centre for the Study of the Ethics of Health Care, Euthanasia and Clinical Practice: Trends, Principles and Alternatives (London, 1982)Google Scholar.
5 See Sacred Congregation for the Doctrine of the Faith, Jura et Bona (Declaration on Euthanasia, 5 May 1980).
6 See Finnis, John, Natural Law and Natural Rights (OUP, 1980), 176–77, 195.Google Scholar
