Neuropsychological Assessment of a Potential "Euthanasia" Case: A Five Year Follow Up.

T. M. McMillan & C. M. Herbert, Neuropsychological Assessment of a Potential "Euthanasia" Case: A Five Year Follow Up, 14 BRAIN INJURY 197 (2000).

In England and Wales, withdrawal of tube feeding requires application to the Supreme Court, where each case is considered on its individual merits. Since 1993, a number of applications have been granted where the individual is clearly in a vegetative state." The picture, however, becomes more complex when the patient is clearly not in a vegetative state, but is severely brain damaged and his or her potential to communicate is greatly restricted by physical injuries.

A twenty-two year old girl sustained a severe head injury in a car accident. She remained in a coma for nineteen days. Over the next eighteen months, she was examined by a number of medical experts and a consensus was reached that she had some level of awareness, but that her cognitive function was little beyond the vegetative state. She was unable to speak or write, she was tetraplegic but had some movement in her right arm. Life expectancy was thought to be fifteen to twenty years. No recovery had been reported over the previous six months and further recovery was deemed extremely unlikely.

Permission was asked of the Court for feeding to be terminated by removing her gastrostomy tube. The weight of medical opinion was that she was in a "low awareness" state which was little beyond a vegetative state, and that, because of this, quality of life must be low and withdrawal of feeding should proceed. Before the case was heard in court, the Official Solicitor to the Supreme Court acting on behalf of the patient and the solicitors acting for the Health Authority who were seeking to withdraw feeding, jointly requested that a neuro-psychological assessment be carried out to more formally determine the patient's level of cognitive functioning and her ability to consent to treatment. Using a buzzer system to indicate yes/no, McMillan found statistically significant evidence that she could make consistent responses to simple commands and autobiogr, aphical questions and clear expressions of a wish to live. The Health Authority requested a second opinion and as a result a similar assessment was carried out a few weeks later, with similar results. [See Shiel and Wilson article abstracted previously.] The request to the Court for permission to terminate involuntary feeding was consequently withdrawn.

Three years after her injury, she was...