Ruling on Bland shows unease at ending life: The fight to withdraw treatment for a Hillsborough victim raises moral issues. Adam Sage reports

PROFOUND unease over the ability of the law to decide when doctors can terminate the lives of their patients is revealed in the judgments delivered yesterday by the House of Lords.

The five law lords are united in believing that Tony Bland's treatment is futile, and fails to serve his best interests. They all say that he should be allowed to die.

But beneath the decision lies an acknowledgement that the case raises complex moral and ethical issues which only Parliament can settle. And there are deep differences of opinion over the propriety of asking judges to rule on Mr Bland's case.

Lawyers said last night that the lead judgment had been given by Lord Goff, who tackled, as a central question, the sanctity of human life. This principle, although fundamental, was not absolute, he said, and life could not be prolonged 'regardless of the circumstances'.

This left doctors to decide what was best for a patient, who, like Mr Bland, could not express his own opinion.

He continued: 'And it is then asked: Can it be in the best interests of the patient that a doctor should be able to switch the life support system off? Such an approach has rightly been criticised as misleading.' The more appropriate question was whether it was 'in the best interests of the patient that his life should be prolonged'.

In the case of Mr Bland, it was clear that the treatment was not just 'futile', but subjected him to indignity 'which must cause considerable distress to his family'. Therefore, 'there is no longer any duty upon the doctors to continue with this form of treatment'.

But Lord Goff pointed to wider, and even more difficult issues. Why is it, he asked, that a doctor who withdraws treatment and allows a patient to die can escape prosecution whereas a medic who injects the same patient, and thereby kills him, is guilty of murder? This distinction 'may lead to a charge of hypocrisy . . . But the law does not feel able to authorise euthanasia, even in circumstances such as these'.

Lord Browne-Wilkinson said: 'I find it difficult to find a moral answer to that question.' But he went further. 'I have no doubt that it is for Parliament, not the courts, to decide the broader issues which this case raises. Until recently, there was no doubt what was life and what was death. A man was dead if he stopped breathing and his heart stopped beating . . . Recent developments in medical science have fundamentally affected these previous certainties.'

Although he accepted that Mr Bland should be allowed to die, he said: 'I am very conscious that I have reached my conclusions on narrow, legalistic grounds which provide no satisfactory basis for the decision of cases . . . where the facts are not identical.'

Lord Mustill echoed this unease, saying ethically there was little difference between withholding treatment, which is legal, and the active steps of 'mercy-killing', which are not. He said the Law Lords' decision 'may only emphasise the distortions of a legal structure which is already both morally and intellectually misshapen'.

Law report, page 26