SPEAK OUT

Published: 14/04/2005, Volume II5, No. 5951 Page 23

The Terri Schiavo case was a family and legal crisis that showed up some of the stark differences between the UK and US.

In the UK cases of this nature are usually held in private, with a suitably anonymised judgement given in public.

In the US they are public affairs.

Another difference was that politicians got involved.

At the heart of the argument is the conflict between principles of individual autonomy and the duty to care, identified in the leading British persistent vegetative state case involving Hillsborough victim Anthony Bland, by Lord Justice Hoffman.

He upheld the decision that the doctors were right to seek to allow Mr Bland to die on the basis of 'respect for the individual human being and in particular for his right to choose how he should live his own life'.

Doctors have a duty to care for their patients and respect their wishes.

Sometimes these come into conflict and, where they do, patients in a fit state to make the decision have the right to refuse life-saving treatment.

Florida law required 'clear and compelling' evidence of an individual's wishes before artificial nutrition and hydration could be discontinued. The court heard the evidence and found the standard was proved.

That decision was examined by superior courts on four occasions and consistently upheld. Therefore it can be clear that the courts decided, after hearing evidence on both sides, that Ms Schiavo did not want to carry on living.

Those who backed Ms Schiavo's parents in arguing for her right to life claimed to uphold the intrinsic value of the continuation of life. That meant extending life whatever the quality of that life and regardless of the wishes of the individual.

From this side of the Atlantic we might find it strange that this is the same political perspective that backs the use of the death penalty.

But the religious line taken in this case is based on the principle that once we lose capacity to decide for ourselves, the state should step in to uphold a Godgiven right to life.

That, as all religious arguments, sees the individual's will subjugated to the divine will. Thus the battle was between the individual's will and the imposed will based on a state-supported theocracy. In the land of the free, all credit goes to the judges who backed individual rights.

The real heroes here were Ms Schiavo's husband Michael, his lawyers and in particular the US judges from the district to Supreme Court, who produced a series of highly sensitive, persuasive and reasoned judgements upholding individual autonomy over those who would take that away as soon as a patient loses capacity.

David Lock is a barrister and head of healthcare at Mills and Reeve. He was formerly an MP and a government minister with ministerial responsibility for family policy.