"ANTHONY BLAND...for the last three and a half years...was totally unaware of the world around him." These were Sir Stephen Brown's opening words in a case that would redefine the law on whether medical professionals can legally stop treating patients in a persistent vegetative state (PVS).
Tony Bland was a normal, healthy 18-year-old who was obsessed with football. On 15 April 1989, he traveled from his home in Keighley to support his team, Liverpool, who played the FA Cup semi-final against Nottingham Forest in Sheffield. The ground's name now became synonymous with disaster as the match was to be played at Hillsborough.
fatal decision
The Hillsborough inquiry, which lasted two years, would later hear the mosaic of evidence that revealed what happened to Tony that day. He had traveled with two friends to watch the game, arriving in Sheffield at 11:15 am. They spent time in a bar and entered the turnstile on the floor at 2:10 pm.
At 2.50pm, 10 minutes before kick-off, Tony was in the already crowded fenced areas 3 and 4, behind the Liverpool goal. Behind him, outside the grounds at the entrance to Leppings Lane, there was a crowd of fans still eager to get in. The police were losing control of the crowd and the Chief Superintendent ordered the opening of a side door normally used as an exit. relieve the pressure, but was unable to order the tunnel leading to the ground to close. Fans entered and walked through the tunnel to the overcrowded paddocks where Tony and other fans were crushed, as one doctor put it, like a "constrictor snake".
When it became clear that there was a serious problem, play was stopped at 15:05. At 3:22 pm, Tony climbed over the fence and was taken into the field by police officers. A police officer and a general practitioner, who was watching the game as a fan, worked to revive him, but he was initially without breathing or pulse. After two minutes of CPR, they got a pulse and the doctor told the officer to continue mouth-to-mouth resuscitation while he left to help other victims. Seven minutes later, Tony was placed in one of the ambulances that were on the field at the time.
crush injury
Later, a police officer inside the ambulance stated that Tony was "thrown on top of the injured adult male who was lying on the ground". Despite the injured man regaining consciousness and becoming restless, Tony's mouth-to-mouth resuscitation continued throughout the trip to Northern General Hospital. When he was handed over to A&E, he was breathing on his own.
The hospital was overwhelmed with victims from Hillsborough that afternoon and Tony was not intubated or transferred to intensive care. The nature of their crush injuries was not immediately apparent, with a doctor stating that they had been told a ground pole had collapsed and were more concerned with identifying and treating potential head injuries.
Tony suffered crush injuries to the chest and bilateral lung collapse, and the resulting hypoxia over a period of more than 20 minutes caused irreversible brain damage. He never regained consciousness, but he retained brainstem function, allowing him to breathe unaided. With a diagnosis of PVS and a prognosis already considered desperate, he was transferred to the care of consultant J.G. Howe, in Airedale, which was closer to his home in Keighley. All attempts by the medical staff and his family to get answers failed and subsequent tests revealed a complete absence of cortical activity. A specialist who evaluated him later stated that it was the worst case of PVS he had ever seen.
Withdrawal of life-supporting treatment
Four months after suffering his injuries, Dr. Howe and the young man's family were already in agreement: Tony should die with dignity because, for all intents and purposes, he had already died that day on the terraces of Hillsborough. Howe contacted the local coroner to outline the plan to remove life support and was told in no uncertain terms that such an action could amount to murder. The coroner also informed the local police, who visited the consultant to confirm that this would be the case. Tony's family was furious and his doctor was surprised by the response, but they resolved to fight.
The hospital fund petitioned the court that "they may legally discontinue all life-sustaining treatments and medical support measures, including artificial ventilation, nutrition and hydration," and their request was granted. However, this decision was later appealed to the House of Lords by the solicitor who had been appointed to act on Tony's behalf. He argued that the withdrawal of artificial treatment, which would inevitably lead to death, constituted murder.
The House of Lords rejected the appeal, thus allowing Tony's doctors to legally suspend treatment. The Law Lords unanimously understood that the suspension of treatment by medical professionals should be seen in law as an omission. Although the omission can be considered homicide when there is a duty to act to save the victim, in this case there is no such duty when the continuation of the treatment is not in the interest of the patient. Continuing treatment in Tony's case was deemed pointless and therefore not in his best interest.
Lord Justice Hoffmann pointed out that the central issue of the case would never have arisen until relatively recently. He went on to say: “A person who lost consciousness irreversibly would have died quickly: from lack of nutrition or from one of the many complications that plagued Anthony Bland's body over the past three years and which medical technology was able to contain. cornered. Thus, modern medicine confronts us with fundamental and painful decisions about life and death that cannot be answered based on normal everyday assumptions.
However, the Law Lords were willing to draw a clear distinction between such an omission and euthanasia (taking active steps to cause death), which remains a criminal offence. The ruling also encouraged medical professionals to request a statement on a case-by-case basis, as circumstances should be assessed on a case-by-case basis.
hillsborough legacy
Tony Bland died on March 3, 1993, and the coroner recorded an accidental death verdict in common with all other victims of the Hillsborough disaster at the time. However, this was later changed as a result of the second Hillsborough inquiry to one of unlawful manslaughter.
This was the worst disaster in British sporting history, with 765 injured and 97 killed. Ninety-four people died that day, ninety-five died a few days later in hospital. Tony would be the 96th victim nearly four years later and the 97th would die from his injuries after 32 years in July 2021.
The 2016 Inquiry fully exonerated the fans and blamed the tragedy squarely at the feet of South Yorkshire Police and the Yorkshire Ambulance Service. The Hillsborough tragedy has many legacies, but shedding light on how patients like Tony Bland who are in PVS can die was one of them.
doctor Allan Gaw is a Scottish writer.
Fuentes
- Airedale NHS Trust v Bland [1993] 1 Todos ER 821 HL
- Conn D. The Guardian, October 16, 2015
- Conn D. The Guardian, April 26, 2016
- Yorkshire Post, April 27, 2016
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