Cardiff University Press Release
30/07/18
For immediate release
Supreme Court judgement “will benefit thousands of patients and families”
Researchers say judgment is an important step forward
Doctors and families of patients in a vegetative or minimally conscious state no longer need to go to court to be allowed to remove life support – where a robust decision-making procedure has been followed and clinicians and the family are in agreement about what is in the best interests of the patient.
A Cardiff University academic researching the treatment of patients with catastrophic brain injuries has welcomed the Supreme Court judgement which was handed down today (July 30). Professor Jenny Kitzinger hailed today’s decision as a positive step forward in patient-centred care and helping to ensure people are not subjected to futile or unwanted treatment.
The case involved anonymous patient Mr Y, who suffered severe brain damage following cardiac arrest in 2017, leaving him in a vegetative state. Two medical experts agreed that Mr Y was in a very low level of responsiveness with no awareness of himself or his environment, and that it was highly improbable that he would emerge into consciousness. The clinical team and Mr Y’s family agreed that it would be in Mr Y’s best interests for Clinically Assisted Nutrition and Hydration (CANH) to be withdrawn.
But until recently, it was believed that an application had to be made to the Court of Protection before this could be done – even if families and doctors agreed it was in the best interests of the patient.
Research by Professors Jenny Kitzinger and Celia Kitzinger, of the Coma and Disorders of Consciousness Research Centre, shows that this can introduce long delays and uncertainty about medical treatment decisions. They argue it involves treating vegetative and minimally conscious patients differently from other patients. Court hearings are also very expensive (about £53,000) and families do not usually have access to legal aid.
Jenny, a professor at Cardiff University’s School of Journalism, Media and Culture, said: “Today’s ruling will save thousands of patients from futile or unwanted treatment and their families across the UK will be spared prolonged pain and distress. We are glad that our research has helped inform such an important debate around end of life care.”
Celia said: “After a severe stroke, or with advanced neurological conditions, it’s common for decisions to be made not to provide or not to continue Clinically Assisted Nutrition and Hydration. These decisions are made by doctors in agreement with families without recourse to the courts. There is no reason to treat patients in vegetative or minimally conscious states differently.”
The researchers emphasised that there are very detailed National Guidelines produced by the Royal College of Physicians, the General Medical Council and the British Medical Association.
Jenny said: “These guidelines should be followed and doctors should consult fully with the family in making a decision about what is best for the patient. Unless there is disagreement or uncertainty, a patient should not be compelled to have months or years of treatment that family and doctors agree are not in the patient’s best interests. The courts of course will remain available as an important resource for addressing cases where there are doubts or disputes.”
In an earlier hearing, the NHS Trust involved in Mr Y’s care sought a declaration that, “it is not mandatory to bring before the Court the withdrawal of CANH from a patient who has a PDOC” (a prolonged disorder of consciousness). The High Court granted a declaration but the Official Solicitor appealed.
Although Mr Y has since died, the Court gave permission for the appeal to proceed, with the judgement being handed down at the Supreme Court today. The Official Solicitor’s appeal was dismissed, with the court ruling there is no obligation in law for doctors and families to seek the court’s approval before removing life support.
ENDS
Notes to editors:
- For further information and to interview Jenny or Celia, contact:
Katie Bodinger
Communications & Marketing
Cardiff University
Tel: 029 20870862
Mob: 07702 819124
Email: BodingerK1@cardiff.ac.uk
- Families affected by these issues can go to the following website for information and to see film of other families’ experiences:
- Further information about the researchers and their work is available at cdoc.org.uk
- Cardiff University
Cardiff University is recognised in independent government assessments as one of Britain’s leading teaching and research universities and is a member of the Russell Group of the UK’s most research intensive universities. The 2014 Research Excellence Framework ranked the University 5th in the UK for research excellence. Among its academic staff are two Nobel Laureates, including the winner of the 2007 Nobel Prize for Medicine, Professor Sir Martin Evans. Founded by Royal Charter in 1883, today the University combines impressive modern facilities and a dynamic approach to teaching and research. The University’s breadth of expertise encompasses: the College of Arts, Humanities and Social Sciences; the College of Biomedical and Life Sciences; and the College of Physical Sciences and Engineering, along with a longstanding commitment to lifelong learning. Cardiff’s flagship Research Institutes are offering radical new approaches to pressing global problems. More at www.cardiff.ac.uk
Datganiad i’r Wasg gan Brifysgol Caerdydd
30/07/18
I’w gyhoeddi ar unwaith
Dyfarniad y Goruchaf Lys “am fod o fudd i filoedd o gleifion a theuluoedd”
Ymchwilwyr o’r farn bod y dyfarniad yn gam pwysig ymlaen
Nid oes angen i feddygon a theuluoedd cleifion sydd mewn cyflwr diymateb parhaol neu led-ymwybodol fynd i’r llys i gael caniatâd i ddod â thriniaeth cynnal bywyd i ben mwyach – cyn belled â bod gweithdrefn benderfynu gadarn wedi’i dilyn, a bod clinigwyr a theulu’r claf yn gytûn ynghylch yr hyn sydd o fudd pennaf i’r claf.
Mae academydd Prifysgol Caerdydd sy’n ymchwilio i drin cleifion ag anafiadau trychinebus yn yr ymennydd wedi croesawu dyfarniad y Goruchaf Lys heddiw (30 Gorffennaf). Dywedodd yr Athro Jenny Kitzinger fod dyfarniad heddiw yn gam cadarnhaol ymlaen mewn gofal sy’n rhoi’r claf yn gyntaf, ac yn helpu i wneud yn siŵr nad yw pobl yn wynebu triniaeth ofer neu ddiangen.
Roedd yr achos o dan sylw yn cynnwys claf dienw, Mr Y, a gafodd niwed difrifol i’r ymennydd yn dilyn ataliad ar y galon yn 2017, gan ei adael mewn cyflwr diymateb. Cytunodd dau arbenigwr meddygol bod lefel ymatebolrwydd Mr Y yn isel dros ben. Nid oedd ganddo unrhyw ymwybyddiaeth o’i hun na’r hyn sydd o’i gwmpas, a’i bod hi’n annhebygol iawn y byddai’n adennill ymwybyddiaeth. Cytunodd y tîm clinigol a theulu’r claf y byddai er budd pennaf Mr Y petaent yn rhoi’r gorau i roi Maeth a Hydradu Cynorthwyol Clinigol (CANH) iddo.
Tan yn ddiweddar, fodd bynnag, y gred oedd bod rhaid cyflwyno cais i’r Llys Gwarchod cyn y gellid gwneud hyn – hyd yn oed os cytunodd teuluoedd a meddygon ei fod er budd y claf.
Dengys ymchwil gan yr Athro Jenny Kitzinger a Celia Kitzinger, o Ganolfan Ymchwil Coma ac Anhwylderau Ymwybod, y gall hyn achosi oedi hir ac ansicrwydd ynghylch penderfyniadau am driniaeth feddygol. Yn eu barn nhw, mae hyn yn golygu bod cleifion mewn cyflwr diymateb a lled-ymwybodol yn cael eu trin yn wahanol i gleifion eraill. Mae gwrandawiadau llys hefyd yn ddrud iawn (tua £53,000) ac yn aml iawn nid yr teuluoedd yn gallu cael gafael ar gymorth cyfreithiol.
Dywedodd Jenny, athro yn Ysgol Newyddiaduraeth, y Cyfryngau a Diwylliant Prifysgol Caerdydd: “Bydd dyfarniad heddiw yn arbed miloedd o gleifion rhag triniaeth ofer neu ddiangen, ac yn arbed poen a gofid hir i’w teuluoedd ar draws y DU. Rydym yn falch bod ein hymchwil wedi helpu i lywio dadl mor bwysig ynghylch gofal diwedd oes.”
Dywedodd Celia: “Ar ôl strôc ddifrifol, neu gyflyrau niwrolegol datblygedig, mae’n gyffredin i benderfyniadau gael eu gwneud ynglŷn â pheidio â darparu Maeth a Hydradu Cynorthwyol Clinigol ai peidio. Gwneir y penderfyniadau hyn gan feddygon ochr yn ochr â’r theuluoedd heb orfod troi at y llysoedd. Nid oes unrhyw reswm dros drin cleifion sydd mewn cyflwr diymateb neu lled-ymwybodol yn wahanol.”
Pwysleisiodd yr ymchwilwyr bod Coleg Brenhinol y Meddygon, y Cyngor Meddygol Cyffredin a Chymdeithas Feddygol Prydain wedi paratoi Canllawiau Cenedlaethol manwl iawn.
Dywedodd Jenny: “Dylid dilyn y canllawiau hyn a dylai meddygon ymgynghori’n llawn â’r teulu wrth ddod i benderfyniad ynghylch yr hyn sydd orau i’r claf. Oni bai bod anghytundeb neu ansicrwydd, ni ddylai claf gael ei orfodi i dderbyn misoedd neu flynyddoedd o driniaeth nad yw’r teulu na’r meddygon yn cytuno sydd o fudd i’r claf. Bydd y llysoedd wrth reswm yn parhau i fod ar gael fel adnodd pwysig ar gyfer mynd i’r afael ag achosion lle ceir amheuaeth neu anghydfodau.”
Mewn gwrandawiad cynharach, gofynnodd Ymddiriedolaeth y GIG oedd yn rhan o ofal Mr Y am ddatganiad, “nid yw’n orfodol dod gerbron y Llys i gael cyngor am CANH gan glaf sydd â PDOC”(anhwylder hir o ymwybyddiaeth). Rhoddodd yr Uchel Lys ddatganiad ond apeliodd y Cyfreithiwr Swyddogol yn ei erbyn.
Er bod Mr Y wedi marw ers hynny, rhoddodd y Llys ganiatâd i’r apêl fwrw ymlaen, gyda’r dyfarniad yn cael ei gyflwyno yn y Goruchaf Lys heddiw. Gwrthodwyd apêl y Cyfreithiwr Swyddogol, gyda’r llys yn dyfarnu nad oes unrhyw rwymedigaeth mewn cyfraith i feddygon a theuluoedd geisio cymeradwyaeth y llys cyn dod â diwedd i driniaeth cynnal bywyd.
DIWEDD
Nodiadau i olygyddion:
- Am wybodaeth bellach ac i gyfweld Jenny neu Celia, cysylltwch â:
Katie Bodinger
Cyfathrebu a Marchnata
Prifysgol Caerdydd
Ffôn: 029 20870862
Ffôn symudol: 07702 819124
Ebost: BodingerK1@caerdydd.ac.uk
- Gall teuluoedd yr effeithir arnynt gan y materion hyn fynd i’r wefan ganlynol am wybodaeth ac i weld ffilm am brofiadau teuluoedd eraill:
- Rhagor o wybodaeth am yr ymchwilwyr a’u gwaith ar gael ar cdoc.org.uk
- Prifysgol Caerdydd
Mae asesiadau annibynnol y llywodraeth yn cydnabod Prifysgol Caerdydd fel un o brifysgolion blaenllaw Prydain o ran addysgu ac ymchwil, ac mae’n aelod o Grŵp Russell, sy’n cynnwys prifysgolion y Deyrnas Unedig sy’n rhoi’r pwyslais mwyaf ar waith ymchwil. Gosododd Fframwaith Rhagoriaeth Ymchwil 2014 y Brifysgol yn y 5ed safle ar draws y DU ar gyfer rhagoriaeth ymchwil. Ymhlith ei staff academaidd mae dau sydd wedi ennill Gwobr Nobel, gan gynnwys enillydd Gwobr Nobel mewn Meddygaeth 2007, yr Athro Syr Martin Evans. Sefydlwyd y Brifysgol gan Siarter Frenhinol ym 1883, a heddiw mae’n cyfuno cyfleusterau modern trawiadol ac agwedd ddeinamig at addysgu ac ymchwil. Mae arbenigedd eang y Brifysgol yn cynnwys: Coleg y Celfyddydau, y Dyniaethau a’r Gwyddorau Cymdeithasol; Coleg y Gwyddorau Biofeddygol a Bywyd; a Choleg y Gwyddorau Ffisegol a Pheirianneg, ynghyd ag ymrwymiad hirdymor i ddysgu gydol oes. Mae Sefydliadau Ymchwil blaenllaw Prifysgol Caerdydd yn cynnig dulliau newydd radical o fynd i’r afael â phroblemau byd-eang pwysig. Ewch i: www.caerdydd.ac.uk