Ethics England Wales

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Clinically assisted nutrition and hydration (CANH)

Decisions to withdraw clinically assisted nutrition and hydration (CANH) from patients in permanent vegetative state (PVS) or minimally conscious state (MCS) following sudden onset profound brain injury

Interim guidance for health professionals in England and Wales from the BMA, Royal College of Physicians (RCP) and General Medical Council (GMC)



The case of Tony Bland in 1993 (who was in a permanent vegetative state (PVS) after being injured at the Hillsborough Stadium Disaster) established that clinically assisted nutrition and hydration (CANH) is a form of medical treatment that can be withdrawn in some circumstances. In that case it was also held that, in England and Wales, prior court approval should be sought for the withdrawal of CANH in all such cases.

There have been a number of recent legal developments that change the way such decisions are made - including recent court judgments and the withdrawal of the Court of Protection’s Practice Direction 9E.


About this guidance

This interim guidance has been published in response to these legal developments and outlines what we consider to be good clinical and professional practice in this area.

These decisions are clinically, legally and ethically challenging for clinicians. We are currently working with the Royal College of Physicians and the General Medical Council to issue updated and in-depth guidance on good clinical and professional practice for making decisions about CANH which we are aiming to publish in May 2018.

This document is published to provide interim guidance for doctors and other clinical professionals pending publication of this new guidance.


Key topics

The interim guidance covers:

  • The latest legal developments
  • Whether and when there is a requirement to seek court approval
  • Assessment of levels of responsiveness and awareness
  • The Mental Capacity Act and best interests decision making
  • Conscientious objection
  • Seeking a second clinical opinion
  • Recording decisions
  • Reviewing decisions

Download the interim guidance