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Court orders 'miracle' drug treatment

Clare Dyer, legal editor
Monday November 20, 2006
The Guardian

A woman in a vegetative state is to be given a "miracle" sleeping pill said to have caused others in her condition to "wake up" after England's senior family court judge overruled the objections of her family in the first case of its kind.

The family of the 53-year-old woman, who has been diagnosed as in a persistent vegetative state (PVS) after a massive brain haemorrhage suffered on holiday in August 2003, want her to be allowed to die with dignity. They say she would not want to live with severe disabilities while being aware of her condition, a likely outcome if the drug, zolpidem, works.

But Sir Mark Potter, president of the high court's family division, ruled this month in a judgment not yet made public that doctors should try the drug before the final decision is taken to withdraw artificial feeding and hydration and let her die.

The move was supported by the official solicitor, Laurence Oates, who represents PVS patients in cases brought by doctors and families seeking court approval for patients to be allowed to die. The 53-year-old woman, who cannot be named, is the first at the centre of a court case in Britain over the drug, but it is now expected to be used in other cases where experts think it might make a difference.

The official solicitor's office sought expert advice on zolpidem after publicity over cases of severely brain-damaged patients who "awoke" and spoke after it was administered. Last September the Guardian reported on several such cases in South Africa and the US.

In a separate development the same month, neuroscientists at Cambridge and Liege in Belgium revealed that they had used a brain scanning technique called functional magnetic resonance imaging (fMRI) to detect signs of awareness in a 23-year-old woman in PVS. It was predicted at the time that the technique would become a standard way of determining the level of consciousness in such patients.

The official solicitor took expert advice on whether the scanning technique should be used on the 53-year-old woman but was told it did not suit her case.

In deciding whether zolpidem should be tried the court heard evidence from Professor Keith Andrews of the Royal Hospital for Neuro-disability in Putney, south-west London, which looks after severely brain-damaged patients.

PVS patients, who may have sustained brain damage in one of a number of ways, such as a road accident or medical mishap, are described as "awake but not aware". Unlike patients in a coma their eyes are open but they see nothing and are not conscious of their surroundings. They breathe normally but have no swallowing reflex and have to be kept alive by artificial feeding and hydration.

The courts first sanctioned the withdrawal of feeding in Britain in the case of Tony Bland, a 21-year-old brain-damaged survivor of the Hillsborough football ground disaster, whose case went to the house of lords, Britain's highest court, in 1993. Law lords ruled that it was in his best interests to be allowed to die and held that doctors could lawfully stop artificial feeding because they would not be killing him, merely withdrawing treatment.

The high court has since sanctioned withdrawal of sustenance from dozens of PVS patients, and several described as in "near-PVS", when doctors, families and the official solicitor all agreed that death was in the patient's best interests.

The Florida case of Terri Schiavo, whose husband fought a seven-year battle before she was allowed to die last year, created a huge debate in the US, but since the Bland case the issue of PVS patients' right to die has had a much lower profile in Britain.