Case Law Update – PC Paul Briggs and the withdrawal of treatment from a patient in a minimally conscious state

Summary

PC Paul Briggs suffered severe brain damage in July 2015 and is now in a minimally conscious state. Clinicians have stated that, should he regain consciousness, he would experience severe permanent mental and physical disability.

As there was no Advance Decision in place and he had not previously registered a Lasting Power of Attorney for Health and Welfare, decisions regarding his treatment must be made in his ‘best interests’ by those responsible for his care.

PC Briggs’ wife, Lindsey Briggs, advised the Court of Protection that the continued administration of artificial nutrition and hydration was not in PC Briggs’ best interests and it should therefore be withdrawn.

Mrs Briggs argued that her husband would not have wished to remain alive in these circumstances, a statement which he had expressed previously. The Walton Centre NHS Foundation Trust and the Wirral Clinical Commissioning Group, who are currently responsible for PC Briggs, argued that removal of the artificial feeding regime would contradict the best interests of the patient and therefore opposed Mrs Briggs’ Application.

Issues

• Previous case law relates only to the withdrawal of artificial nutrition and hydration from patients in an uncontested permanent vegetative state, not patients such as PC Briggs who are in a minimally conscious state and therefore have at least partial preservation of conscious awareness.
• PC Briggs has some level of awareness but an inconsistent and limited ability to respond or communicate. He is currently able, on good days, to press a buzzer in response to a question.
• Whilst Mrs Briggs argued that keeping her husband alive would be akin to torture, the Trust stated that he was not likely to be tormented or trapped psychologically by his condition, but withdrawing artificial hydration and nutrition would cause him to starve to death and likely to cause him pain and suffering.
• Evidence was heard to the effect that PC Briggs could potentially have some positive experiences in the future and he could become content in a situation that he would previously have considered unacceptable. Counsel for the Trust therefore argued that PC Briggs should not be deprived of a future in which he might become content.

Judgment

On 20 December 2016, the Court of Protection ruled that clinicians should stop providing life-supporting treatment to PC Briggs as treatment could be lawfully withdrawn.

It was held that, although there is a very strong presumption in favour of preserving life, the weightiest, and so determinative factor, in determining what was in PC Briggs’ best interests is what PC Briggs would have felt was in his own best interests.

Mr Justice Charles stated that: “I am sure that if Mr Briggs had been sitting in my chair and heard all the evidence and argument he would… not have consented to further CANH treatment… This means that the Court is doing on behalf of Mr Briggs what he would have wanted and done for himself in what he thought was his own best interests if he was able to do so.”

The Official Solicitor has advised that they intend to seek leave to Appeal.

What this means for you

For further information on the issues raised by this update, please get in touch.