Right-to-life patient's family 'want to believe' he can respond, says expert

http://www.guardian.co.uk/law/2012/aug/21/right-to-life-patient-expert

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The family of a Muslim man left in an apparently persistent vegetative state after a heart attack five weeks ago "strongly feel" that he is able to understand and respond to them, contrary to what medical experts believe, the high court has heard.

One expert told the court of protection in London it was a case of family members "wanting to believe" that the brain-damaged patient, referred to as L, was capable of responding.

The 55-year-old patient's family, from Greater Manchester, are fighting a legal battle for him to receive life-saving treatment if his condition worsens.

Lawyers for the family argue that he would never agree to an order that he should not be resuscitated or ventilated, as it is a tenet of his Muslim faith that life is sacred.

Pennine Acute Hospitals NHS trust, which is responsible for L's care, is seeking a court declaration that it would not be in his best interests to offer treatment if there was "a life-threatening event", and that treatment should be limited to what doctors consider reasonable to maintain his dignity and relieve pain and discomfort.

The family say it is too soon to determine whether L is in a permanent vegetative state or to conclude that his quality of life would be so limited as to make life-saving treatment futile.

On the second day of the hearing, a statement was read from L's wife that said: "We feel strongly that L is able to understand us, hear us and we believe that he reacts."

The family's evidence was challenged by Dr Michael Bell, an independent expert in intensive care with regular experience of cases of persistent vegetative state (PVS). He was jointly instructed by both parties to examine L, and told the court he did not foresee L undergoing any "meaningful neurological recovery".

He described PVS as a state of being "awake, with open eyes, but not aware" and not showing "any sign of environmental awareness, or self-directed movement or activity". He suggested none of L's responses in videos submitted by the family were meaningful, and all the movements detected were compatible with a PVS diagnosis.

The doctors, nursing staff and physiotherapists involved in caring for L had also not detected any evidence of "reproducible responses or volitional activity", he said. He agreed that if there had been such responses L would have been classified as "minimally conscious".

He said he could not "clinically" explain the family's perceptions of L's condition. But it could be explained "on the basis that they want to believe he is capable of recognising that they are there and making some response".

A ruling is expected later this week.