Airedale NHS Trust v Bland [1993] AC 789 (HL)

Facts

• Anthony Bland suffered severe brain damage during the 1989 Hillsborough disaster, resulting in a persistent vegetative state.
• For over two years, he exhibited no signs of recovery and was kept alive through artificial feeding via a tube.
• The medical team at Airedale NHS Trust concluded there was no prospect of improvement and sought a court declaration to lawfully discontinue life-sustaining treatment.
• The official solicitor, acting for Bland, appealed the initial court order permitting cessation of treatment, bringing the matter before the House of Lords.
• The core question was whether the hospital could lawfully withdraw artificial feeding and life support measures in these circumstances.

Issues

1. Whether the withdrawal of life-sustaining treatment from a patient in a persistent vegetative state constitutes an unlawful act or a permissible omission.
2. Whether such withdrawal amounts to murder or is justified as acting in the patient's best interests where there is no hope of recovery.
3. Whether medical practitioners have a legal obligation to continue life support in circumstances where the treatment no longer offers a genuine medical benefit.

Decision

• The House of Lords held it was lawful for the hospital to withdraw artificial feeding and life support.
• The withdrawal was characterized as an omission, not a positive act intended to cause death.
• The court determined there was no continuing legal duty to provide treatment that was not in the patient's best interests, given the absence of any prospect of recovery.
• Several judges expressed reservations about the moral and intellectual validity of the act/omission distinction, but recognized its necessity for the legal outcome.
• The ruling formally differentiated between actively causing death (which remains unlawful) and discontinuing treatment.

Legal Principles

• The distinction between acts and omissions is central; an omission to provide or continue futile treatment is not unlawful if continuing the treatment is not in the patient's best interests.
• Medical practitioners are not legally obliged to prolong life by treatment that confers no genuine benefit.
• Lawful withdrawal of life-sustaining treatment is possible under judicial oversight when the patient lacks decision-making capacity and treatment offers no prospect of recovery.
• The legally recognized concept of “best interests” guides decisions for incapacitated patients.

Conclusion

Airedale NHS Trust v Bland established that doctors may lawfully withdraw life-sustaining treatment from patients in a persistent vegetative state where continuation is not in the patient's best interests. The judgment distinguished between unlawful acts and permissible omissions, providing enduring guidance on end-of-life medical decision-making.