Report on Bioethics: Advance Care Directives - Law Reform ...

1.27 Two of the Law Lords also expressed views on the potential legalstatus of advance care directives. Lord Keith stated: 29―an adult, who is conscious and of sound mind…is completely atliberty to decline to undergo treatment, even if the result of his doingso is that he will die. This extends to the situation where the person,in anticipation of his... entering into a condition such as PVS, givesclear instructions that is such event his is not to be given medicalcare, including artificial feeding, designed to keep him alive.‖1.28 Similarly, Lord Goff stated: 30(b)―a patient of sound mind may, if properly informed, require that lifesupport should be discontinued: see Nancy B v Hotel-Dieu deQuebec. 31 Moreover, the same principle applies where the patient‘srefusal to give his consent has been expressed at an earlier date...though in such circumstances especial care may be necessary toensure that the prior refusal of consent is still properly to be regardedas applicable in the circumstances which have subsequentlyoccurred (see eg Re T (adult: refusal of medical treatment). 32 ‖Case law after Bland1.29 In Re C, 33 a 68-year old man with chronic paranoid schizophreniasuffered from the delusion that he was a world famous doctor who had neverlost a patient. He developed gangrene in his leg, but refused amputation despitethe hospital‘s assessment that he would die immediately if the operation wasdelayed. He sought an injunction to prevent the hospital from amputating his legin the future. Thorpe J was prepared to find him competent and granted theinjunction. Mr C survived without the amputation. Re C is an illustration thatadvance care directives are not confined to end-of-life situations but alsoinvolve the continuation of care.1.30 In Re AK, 34 a 19-year old patient suffered from a progressive neuromusculardisease causing paralaysis. He informed his carers, by means of aneyelid movement, that he would wish his artificial ventilation to be stopped if hecould no longer communicate. The health authority applied to the High Court for293031323334[1993] 1 All ER 821, at 860.Ibid, at 866.(1992) 86 DLR (4 th ) 385 (Quebec Superior Court).[1992] 4 All ER 649.[1994] 1 WLR 290.[2001] 1 FLR 129.16