Patient is 'competent' to choose death over life

A paralysed woman who wants to be allowed to die watched by videolink from her hospital bed yesterday while two psychiatrists told the High Court in London that she was mentally competent to choose death over life.

In the first case of its kind, the psychiatrists reluctantly agreed that the woman was psychologically fit to ask that the ventilator keeping her alive should be switched off but they hoped that giving her the choice might actually make her want to live.

The woman listened intently as her mental condition was described in detail to Dame Elizabeth Butler-Sloss, president of the Family Division of the High Court. The patient was paralysed from the neck down after suffering a ruptured blood vessel more than a year ago. An order prevents the woman, the hospital and the medical staff involved in her care being named.

The judge asked the first psychiatrist: "Is it a danger that we ourselves are emotionally involved in this case? None of us would wish to be involved in the death of anyone else." He replied: "Yes, indeed. Emotion rules our reason and not the other way around."

After a morning of evidence during which he said he "grieved" that someone with the vitality of Miss B [her legal name] should want to die, the eminent psychiatrist said: "From where I am sitting, the ideal conclusion to be reached by the court would be that Miss B is found to be mentally competent but that she then goes on to make a choice to go for further treatment."

The patient, a 43-year-old single, childless social-care professional, brought the case against the hospital because she feels her poor quality of life since suffering the rupture has made her existence intolerable.

After hearing the opinion of the first psychiatrist, the patient could be seen nodding vigorously when Dame Elizabeth told him: "At the end of [Miss B's] evidence, she said she agreed that if she had a choice, she might at least consider the possibility of the rehabilitation but then she would want the right to say 'enough is enough' and bring the rehabilitation attempt to an end."

If the ventilator were to be switched off, the patient would be dead within hours. Dame Elizabeth has made it clear that the court's role is not in judging the rights or wrongs of Miss B's decision, but her competence to make the choice.

The second psychiatric expert was asked where he would put Miss B on a scale of competence. He replied: "I would reluctantly say I would put her on the extreme end of considerable competence."

He went on to say that having control over whether she remained on a ventilator "would have a profound effect on how she sees herself on a day-to-day basis and would improve the quality of her life".

The first psychiatrist said he had been concerned that the patient might be "regressing" into childhood as a defence mechanism. Recalling the most disturbing instance, he said: "There was a reference by Miss B that when she is being toileted she closes her eyes and says, 'Rag doll, rag doll, rag doll'." This expression, he said, was used by Miss B as a child when she was subjected to "severe adversity" at the hands of her father.

The hearing concludes today.