Ethics England Northern Ireland Wales

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Withdrawing or withholding artificial nutrition and hydration in relation to an adult in a minimally conscious state

A recent judgment in the High Court has re-emphasised the requirement that all decisions relating to the withdrawing or withholding of artificial nutrition and hydration in relation to an adult in a minimally conscious state must be referred to the Court.

Although the requirement to refer such decisions in relation to adults in a vegetative state is more widely known, in the case of Re: M the Court made reference to Court of Protection Directive 9E which states:

"Cases involving any of the following decisions should be regarded as serious medical treatment for the purpose of the Rules and this practice direction, and should be brought to the court:

(a) decisions about the proposed withholding or withdrawal of artificial nutrition and hydration from a person in a permanent vegetative state or a minimally conscious state;

(b) cases involving organ or bone marrow donation by a person who lacks capacity to consent; and

(c) cases involving non-therapeutic sterilisation of a person who lacks capacity to consent."


Doctors treating patients about whom such decisions are being considered should seek legal advice from the relevant trust solicitors.

Members of the Official Solicitor's staff are prepared to discuss applications in relation to serious medical treatment before an application is made.

Any enquiries about adult medical and welfare cases should be addressed to a family and medical litigation lawyer at:

The Office of the Official Solicitor
81 Chancery Lane
London WC2A IDD

Tel: 020 7911 7127
Fax: 020 7911 7105
Email: [email protected]


Further resources

Withholding and Withdrawing Life-prolonging Medical Treatment, 3rd Edition

Written and edited by members of the Medical Ethics Department of the British Medical Association with advice from the BMA’s Medical Ethics Committee.

Purchase online

Morals and medicine webcast

View a webcast on this issue from the morals and medicine event.

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