Withdrawal of life support and religious belief: St George’s Healthcare NHS Trust v P & Anor

The facts

P is a devout Sunni Muslim. In November 2014 he had a major cardiac arrest and it was 25 minutes until spontaneous circulation was restored, with the result that he suffered serious brain damage. He is now wholly dependant on the Intensive Care Unit at St George’s Hospital for his care, which includes renal replacement therapy (RRT); and in St George’s Healthcare NHS Trust v P & Anor [2015] EWCOP 42, the NHS Trust sought declarations that P lacked capacity (which was uncontentious), that it was not in his best interests to receive cardio-pulmonary resuscitation in the event of a further cardiac arrest (also uncontentious) and

“As to whether it is lawful to continue to provide RRT, the Trust wish to discontinue life sustaining treatment with the inexorable and inevitable consequence that as a result P would quickly die” [2].

There was a dispute about the diagnosis: in short, whether P was in a permanent vegetative state or a minimally conscious state: however, there was little dispute between the experts that the prognosis was that he was unlikely ever to make a full recovery [12].

The judgment

In coming to a conclusion, Newton J particularly bore in mind [18] that

“Best interests must be given a generous interpretation … The infinite variety of the human condition never ceases to surprise and it is that fact that defeats any attempt to be more precise in a definition of best interests:” per Hedley J in Portsmouth NHS Trust v Wyatt [2005] 1 WLR 3 995.

He also quoted at length [19] the lead opinion given by Baroness Hale of Richmond in Aintree University Hospitals NHS Foundation Trust v James & Ors [2013] UKSC 67.

Of particular interest for students of law and religion, he also addressed the issue of P’s own views on assisted dying. P had made no valid or applicable advance decision prior to his loss of capacity that addressed medical treatment generally or the withdrawal of life-sustaining treatment specifically, nor had he created any lasting power of attorney; however, P’s family and friends had given what Newton J regarded as very strong evidence of P’s views, as follows:

“(1) Prior to his injury he told his cousin that he did not agree that people should be assisted to die, and that a life was no less valuable or less worth living if a person was chronically disabled or ill. That was powerfully confirmed by his cousin in evidence.

(2) P was a deeply religious man. He strongly believed that life was sacred given by God and could only be taken away by God.

(3) As a Sunni Muslim he believed that suffering was a component of predestination and someone else should not play an assisting role in shortening life merely because of the subjective quality of that life. It is against the tenet of his faith to do anything to shorten a life.

(4) He had powerful wishes and feelings which were well expressed and which should not be supplanted or substituted by anyone else’s view…” [38].

He inferred that P would wish to ensure that “life-preserving treatment should continue whatever may befall him” [38]. He attached considerable weight to the expressions of family members and friends with direct knowledge of P’s knowledge, understanding and philosophy, “in particular those who know about his beliefs and values” [40]:

“In the light of his previously expressed strong views, coupled with his strong religious beliefs, the weight of the evidence all falls heavily to one side which is that the preservation of any life would be considered by P to be of significant value. His present circumstances are a life which P would find worthwhile, even though I entirely accept many others would not adopt the same position” [41].

Though full emergence from a minimally conscious state was not anticipated, it could not be discounted that P’s level of consciousness might improve: he already showed a markedly different response to his family than to professionals and

“that might suggest that he recognises them, and draws comfort from their activities and presence. He clearly responds to the love and affection which they show him. It would therefore be absolutely premature on any view to find that there could yet be no improvement in the quality of the experience of life for P” [42].

In those circumstances, the balance lay strongly in favour of preserving P’s life through the continued provision of RRT:

“(1) On any view the treatment is not futile, it preserves his life and may do so … for perhaps some four years or more … It seems to me that he gains pleasure and comfort from the love and affection that he receives from his family and that is a continuing illustration not just of his conscious state but also of the importance of the continuation of such treatment.

(2) The treatment is not overly burdensome…

(3) The treatment is not without a prospect of success… [I]n any event it preserves the quality of life that he currently has now and therefore on the evidence I regard it as worthwhile in accordance with his previous beliefs and values and expressed views” [44].

There was almost nothing, on the facts, to rebut the very strong presumption that it was in P’s best interests to stay alive; and Newton J therefore directed that the RRT should continue [45].

Cite this article as: Frank Cranmer, "Withdrawal of life support and religious belief: St George’s Healthcare NHS Trust v P & Anor" in Law & Religion UK, 6 July 2015, https://lawandreligionuk.com/2015/07/06/withdrawal-of-life-support-and-religious-belief-st-georges-healthcare-nhs-trust-v-p-anor/

2 thoughts on “Withdrawal of life support and religious belief: St George’s Healthcare NHS Trust v P & Anor

  1. “P was a deeply religious man. He strongly believed that life was sacred given by God and could only be taken away by God.”

    Couldn’t it be reasonably argued that by having a cardiac arrest and waiting 25 minutes for circulation to be restored, that was God trying to take away and modern medicine getting in the way?

    Similarly, “As a Sunni Muslim he believed that […] someone else should not play an assisting role in shortening life merely because of the subjective quality of that life.” But what about lengthening life based on an equally subjective quality of that life?

    If the state, public and medical profession are having a say on when and how a life can be artificially sustained through life support machines, aren’t they also rightly or wrongly in a position to say when and how that sustenance can be terminated?

    • Fair enough: I wasn’t commenting on the opinions of the claimant and defendant, merely reporting the facts and the judgment! But as to your last point, surely the problem is that different parties sometimes take opposing views as to whether or not life-support should be continued in an individual case. And as I regularly find myself writing, almost every case turns on the individual facts.

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