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Assessing best interests in end-of-life care for a patient in a minimally conscious state
  1. Martin Curtice
  1. Consultant in Old Age Psychiatry, Worcestershire Health and Care NHS Trust, The Princess of Wales Community Hospital, Bromsgrove, Worcestershire
  1. Correspondence to martin.curtice{at}


The legal basis and principles for the lawful withholding of life-sustaining treatment from people in a minimally conscious state have been laid out in the Supreme Court judgment in Aintree University Hospitals NHS Foundation Trust (Respondent) vs James (Appellant) [2013]. This was the first case under the Mental Capacity Act 2005 to come before the Supreme Court and hence it is of legal importance. The case involved a 68-year-old man who had multiple physical co-morbidities and who was diagnosed as being in a minimally conscious state. This article discusses the Supreme Court case and the approach taken by the Court of Protection and the Court of Appeal in applying the Mental Capacity Act 2005 when assessing whether withholding life-sustaining treatment is ever in a person's best interests. It also outlines two similar cases from 2014. In so doing it demonstrates how the courts assess best interests in end-of-life care for people in minimally conscious states and how this differs legally from those in a persistent vegetative state.

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