Family of Muslim man in right-to-life court battle

Manchester man in vegetative state but family says their faith calls for life to be prolonged as long as possible.

The family of a Muslim man left in an apparently vegetative state after a heart attack five weeks ago caused severe brain damage have begun an appeal to ensure he will be given life-saving treatment, against the advice of clinicians, if his condition worsens.

A judge at a court of protection in London heard that patient L, a 55-year-old man from Greater Manchester who cannot be named, was being treated by Pennine acute hospitals NHS trust. The trust is seeking a court declaration that it would not be in patient L's best interests to offer him ventilation or resuscitation if there was a life-threatening event or any other deterioration.

The patient's family who have a strong religious faith, argue that it is too early to make the decision and are asking for more time to see whether his condition improves. They claim that within days of his cardiac arrest a "do not resuscitate" notice appeared in his notes without their knowledge, and in contravention of the trust's own policy. When his family learned of the notice, they objected and it was removed.

In a written statement to the court, L's wife of more than 40 years said they had several adult children and were "a very close family". Her husband was a happy, loving person "and a loving and caring father".

L, who has had two previous heart attacks, suffered a third cardiac arrest in mid-July, which led to his current condition and treatment in a high-dependency unit (HDU). The NHS trust says treatment should be limited to what doctors consider reasonable to maintain his dignity and to relieve any pain and discomfort he may be feeling, but should not extend to resuscitation or ventilation.

His life expectancy could be many months or longer. L's family wants the judge to rule that "all steps" should be taken to preserve his life. One of his sons, referred to as FL, said Muslims in general "believe that you prolong life as far as you can go and that you actively take every step to so do".

He added: "My father was very aware of these issues and often when we heard stories in the media about negligence and decisions to turn off life-support, he would wince his face and give a look of disapproval. It was a solemn look of disapproval and sadness."

L had ensured his own father's life was prolonged when he was seriously ill, FL said. The family does not believe L is as unresponsive as the doctors suggest and say they have observed "some degree of responsiveness".

The case has come before the court as L, whose interests are being represented by the official solicitor, is a vulnerable adult whose condition means he lacks the capacity to make decisions about his medical treatment. His family believes that if L could express his wishes he would not agree, because of his faith, to an order that he should not be resuscitated or ventilated.

Claire Watson, appearing for the trust, said it was the unanimous view of clinicians treating L, as well as independent experts, that he was in a persistent vegetative state "with minimal prospects of improving any neurological function and no meaningful prospect of further recovery".

She said: "Rather than there being the prolongation of life, there would be the prolongation of death and lack of dignity."

The trust said L suffered a hypoxic brain injury as the cardiac arrest was so severe. The clinicians said he was in a vegetative state resulting from severe brain damage, a diagnosis that was confirmed by a consultant neurologist on 25 July.

L was taken off the ventilator and was breathing independently two days later, after he had a tracheotomy. On 3 August he was moved to the HDU and is now in a stable condition. He has a very poor prognosis, according to the clinical team.

An intensive care consultant said he had not been able to elicit "any purposeful response" from L, and said he would not "significantly improve". Another consultant, who specialises in anaesthetics and critical care, estimated there was "less than 1% chance of meaningful recovery".

Any recovery would be very limited and leave L "profoundly physically and mentally impaired". Although L's eyes opened spontaneously they do not focus or follow movement. He is tube-fed, has a catheter and does not move or respond to verbal command or physical stimulus. Watson said L was unable to interact with his surroundings and would always be dependent on others. He was prone to respiratory deterioration, skin and urinary infections and the risk of pneumonia.

An independent expert in intensive care, jointly instructed, said it was "absolutely unrealistic" to expect any further neurological recovery from such a "minimally conscious state". The expert supported the trust's position. An expert in neurology, also jointly instructed, accepted that prognosis was notoriously difficult in PVS cases but supported the trust's position. The law requires a doctor to provide treatment and care in the best interests of a patient such as L, who is incapable of making decisions for himself.

The trust accepted that, in assessing best interests, the court was not limited to considering "best medical interests" and had to take account of the beliefs and values likely to influence L if he could make his own decision. The court also had to consider the views of family members.

Watson argued that the patient views and his family's were highly material but were "not the governing factors".