Advice and development

Passing judgement on life and death

A seminar on legal issues when people are on a life-support machine helped nursing student Duncan Hamilton understand the processes behind the difficult decisions made by judges in the Court of Protection. 

A seminar on legal issues when people are on a life-support machine helped nursing student Duncan Hamilton understand the processes behind the difficult decisions made by judges in the Court of Protection.


When difficult decisions must be made, judges must gauge a person's quality of life
 Picture: Getty

I recently attended a fascinating seminar on law at the end of life, hosted by RCN legal services at the college’s headquarters in London. 

Keynote speaker Sir Mark Hedley spent the latter part of his career as a judge in the Court of Protection, which rules on decisions such as the withdrawal of life support. 

As nursing students, we are instructed to practise without judgement. But when a difficult decision had to be made, it was Sir Mark’s job to judge the value of a person’s quality of life.

Given that fundamental contrast, what struck me as he described his role was the compassion and empathy with which Sir Mark spoke.

Important decisions 

He talked of having to navigate who ‘owns’ the decision about end of life care when the patient has no capacity to make it themselves, of balancing tensions between the needs of the person and the views of their family, healthcare professionals and judges. 

Treading this line isn’t easy, he said, especially regarding issues such as faith. He passed judgement, he said, with reference to the faith of the person and the family, so they can better relate to and accept it.

This kind of empathetic relating is fundamental to nursing care, and I was glad to hear it in Sir Mark’s approach to such important decisions. He has acted as the final arbiter in many cases: appeals on points of law are allowed, but on the facts a judge is absolutely unquestionable.

Judges enjoy unparalleled independence, with no regulatory body like the Nursing and Midwifery Council for oversight. It sounds dangerous, but I found myself thinking it had to be that way. When someone must make a decision to allow a person to die, it should be with the utmost freedom and protection to choose well. I’m not sure how I would cope emotionally with that level of responsibility.

Greater transparency 

Everyone present praised Sir Mark’s honesty in talking about the processes behind decisions. He admitted that identical facts could come before another judge and a different decision could be made based purely on the judge’s values. 

Even with that responsibility, he said life or death decisions were often among the clearest: it was decisions on issues such as amputation that would keep him up at night, especially given the uncertainty in medical outcomes. It’s not a job I think I could volunteer for; nursing is tough enough.

Nurses have been making huge efforts to tackle the stigma surrounding death and dying, and Sir Mark has long supported greater legal transparency. In May 2010, he made history as the first judge to allow journalists into the Court of Protection. Last November, the hearing about whether life support treatment should be withdrawn for police officer Paul Briggs was live-tweeted. 

This is a great demonstration of care cutting across professional boundaries. People like Sir Mark are part of the healthcare team and we are fortunate to have them. 


About the author 

 

 

 

Duncan Hamilton is a nursing student at the University of Surrey and member of the RCN Ethics Network 

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