## Facts

- Anthony Bland suffered hypoxic brain damage in the 1989 Hillsborough disaster, destroying all higher brain function while leaving brainstem function intact.
- He was diagnosed as being in a persistent vegetative state (PVS) and remained totally unaware of his surroundings for more than three years.
- Bland could breathe unaided but required total nursing care; nutrition and hydration were provided through a nasogastric tube.
- Medical experts unanimously agreed there was no prospect of recovery or improvement.
- Bland lacked capacity and had left no advance directive; his family and treating clinicians agreed continued life-sustaining treatment was no longer appropriate.
- The hospital authority sought court declarations that it would be lawful to discontinue artificial nutrition and hydration and other life-prolonging measures, while providing palliative care to permit death with minimal suffering.
- The High Court granted the declarations; the Court of Appeal affirmed; the Official Solicitor appealed to the House of Lords.

## Issues

1. Whether artificial nutrition and hydration delivered by nasogastric tube is properly classified as “medical treatment” rather than basic care.
2. Whether doctors may lawfully withdraw life-sustaining treatment from an incompetent PVS patient with no prospect of recovery.
3. Whether withdrawal of such treatment, with death as a foreseeable result, constitutes murder or manslaughter.
4. How the “best interests” standard applies to an adult lacking capacity in the context of the sanctity-of-life principle.
5. What safeguards should govern decisions to withdraw artificial nutrition and hydration from PVS patients.

## Decision

- The House of Lords unanimously dismissed the appeal and affirmed the declarations.
- Artificial nutrition and hydration via nasogastric tube was treated as medical treatment.
- Doctors have a duty to act in the patient’s best interests, which may permit discontinuing treatment that is futile and confers no benefit.
- Where competent medical evidence establishes PVS with no prospect of recovery, continued life-sustaining treatment (including artificial feeding) may be found contrary to the patient’s best interests.
- Withdrawal in these circumstances would not constitute murder or manslaughter because the doctor is omitting further treatment for which there is no continuing legal duty, and death results from the underlying condition.
- The court endorsed the continuation of palliative care and emphasized the need for careful medical evidence and judicial oversight for PVS withdrawal decisions.

## Legal Principles

- Artificial nutrition and hydration administered through clinical means can constitute medical treatment subject to the same legality analysis as other interventions.
- A clinician is not legally required to continue life-prolonging treatment that is medically futile and provides no therapeutic benefit to an incompetent patient.
- For an incompetent adult, treatment decisions are governed by an objective best-interests standard; family views may inform but do not control that determination.
- The sanctity-of-life principle is fundamental but does not mandate prolonging biological life by all possible measures when treatment yields no benefit.
- Withdrawing non-beneficial life-sustaining treatment is legally characterized as an omission to continue treatment, not a positive act of killing, where no duty to continue exists; active steps taken to cause or hasten death remain unlawful.
- Given the gravity of withdrawing artificial nutrition and hydration from PVS patients, court declarations and clear, unanimous expert evidence function as safeguards to ensure lawful decision-making.

## Conclusion

The House of Lords held it lawful, in a strictly limited PVS context supported by clear medical evidence, to withdraw artificial nutrition and hydration and other futile life-sustaining treatment when continuation is not in the patient’s best interests, treating the resulting death as attributable to the underlying condition rather than unlawful killing.


Airedale NHS Tr. v. Bland, [1993] 1 All E.R. 821 (H.L. 1993)