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Court rules patient can die as drug fails

Thu Dec 07 01:00:35 UTC 2006

Stop treating me, says teenager with leukaemia

Thu Dec 07 01:20:18 UTC 2006
A woman who fell into a persistent vegetative state after a brain haemorrhage is to be allowed to die with dignity after a last attempt to wake her failed. A 16-year-old girl who has undergone two bone marrow transplants in her fight against cancer has chosen to forego further treatment.
Doctors had said that Zolpidem - nicknamed the Lazarus drug after it roused several PVS patients - offered a "glimmer of hope" for the 53-year-old. But her husband, mother and two daughters, who the courts heard had visited her in hospital devotedly during the past three years, had all insisted that she should be allowed to die. From previous conversations with her, they said they were in no doubt she would not wish her life to be prolonged in her present condition. Josie Grove, from Corbridge in Northumberland, was diagnosed with leukaemia two years ago. She received bone marrow from her younger brother before he was born and, after suffering a relapse, from an anonymous donor, before being told her cancer was terminal. Her family are in full support of her decision to concentrate on enjoying life rather than suffer any further treatment.
And yesterday, the country's most senior family judge granted their wish after hearing she had failed to respond to the Zolpidem. The talented artist and swimmer, who will accept a bravery award today after being nominated by her nurses, said yesterday: "I've had enough of hospitals. A course of drugs I took in September left me feeling ill, shaky and aching, and it didn't do much to fight the cancer. I want to get on with my life and enjoy spending time with my family."
Sir Mark Potter, president of the High Court's family division, who earlier approved the drugs trial, revealed that it had no significant effect and he was satisfied that "I should make the declarations sought". Miss Grove said when she learnt she had myeloid leukaemia, while her family lived in Thailand, she did not realise it was cancer. "But when I later found out what it was, I didn't let it affect me," she said.
The High Court had heard that the woman known only as J - a fun-loving person with many friends and a close-knit family - had fallen into a PVS while on holiday in August 2003 and never regained consciousness. Her family returned to the UK so she could be treated. Her father Cliff, 46, said: "Out little boy Charlie [now eight months old] turned out to be a 100 per cent bone marrow match and the doctors were able to take bone marrow from the umbilical cord."
Her case reached the courts after the NHS trust treating her sought rulings that it would be lawful to discontinue and withhold life-sustaining treatment and medical support, including nutrition and hydration, in a way that ensured she suffered the least distress "and retains the greatest dignity until her life comes to an end". Doctors said Miss Grove's bone marrow matches just one in six million people.
But Laurence Oates, the outgoing Official Solicitor who represents the interests of patients who could not represent themselves, proposed the three-day Zolpidem drug trial. And Sir Mark gave the go ahead last month after advice from Professor Keith Andrews, of the Royal Hospital for Neuro-disability in Putney, south-west London. But despite radiation and chemotherapy his daughter suffered a relapse less than six months after the transplant at the Royal Marsden Hospital in Surrey. Last May, she had a second bone marrow transplant from an anonymous donor at Newcastle General Hospital. She now has fortnightly blood transfusions.
Zolpidem, normally used to help insomnia, has been cited in several cases where it has roused patients in a persistent vegetative state. Mr Grove said: "The transplants were pretty tough. She has just had enough of it and she is not frightened of the future and can understand it."
J's family feared that if the treatment worked, it might give her an insight into her condition, causing her "sadness and pain". Mr Grove and wife Jacqui, 44, approve of her decision to die at home. " She is a strong character and has even made it easier for us. We are just taking each day as it comes," they said.
But Professor Andrews maintained that - while Zolpidem only offered a slim outside chance of working - it was important that she be given any chance to recover, however remote. Miss Grove, who left school in September due to her illness, will spend Christmas with her brothers Freddie, 13, and eight-month-old Charlie, and 11-year-old sister Libby.
Ruling yesterday that the NHS trust could now withdraw life-sustaining treatment, with the new Official Solicitor supporting the application, Sir Mark said: "J has had administered to her a three-day course of Zolpidem, witnessed by her family on 14, 15 and 16 November 2006. Her courage has been recognised by the Brave Hearts charity. She will be honoured at a ceremony at Newcastle United's St James's Park today.
"J was carefully watched for any response or sign of increased awareness. The drug produced no increased responsiveness and instead appeared to make her fall asleep, that is to say it had its normal effect."
PVS patients are "awake but not aware". They breathe normally but have noswallowing reflex and are kept alive by artificial feeding and hydration.
British courts first sanctioned the withdrawal of feeding in 1993, in the case of Tony Bland, a 21-year-old brain-damaged survivor of the Hillsborough football ground disaster. Law lords ruled that it was in his best interests and 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, when doctors, families and the Official Solicitor agreed death was in the patient's best interests.