When 'Sanctity of Life' and 'Self-Determination' clash: Briggs versus Briggs [2016] EWCOP 53 - implications for policy and practice.

In a landmark judgment in the English Court of Protection, the judge (Charles J) found it to be in the best interests of a minimally conscious patient for clinically assisted nutrition and hydration (CANH) to be withdrawn, with the inevitable consequence that the patient would die. In making this judgment, it was accepted that the patient's level of consciousness - if CANH were continued and rehabilitation provided - might improve, and that he might become capable of expressing emotions and making simple choices. The decision to withdraw treatment relied on a best interests decision, which gave great weight to the patient's past wishes, feelings, values and beliefs, and brought a 'holistic' approach to understanding what this particular patient would have wanted. We draw on our own experience of supporting families, advocating for patients and training healthcare professionals in similar situations to consider the implications of the published judgment for policy and practice with patients in prolonged disorders of consciousness and their families.

Withdrawing artificial nutrition and hydration from minimally conscious and vegetative patients: family perspectives.

In W v M, family members made an application to the Court of Protection for withdrawal of artificial nutrition and hydration from a minimally conscious patient. Subsequent scholarly discussion has centred around the ethical adequacy of the judge's decision not to authorise withdrawal. This article brings a different perspective by drawing on interviews with 51 individuals with a relative who is (or was) in a vegetative or minimally conscious state (MCS). Most professional medical ethicists have treated the issue as one of life versus death; by contrast, families--including those who believed that their relative would not have wanted to be kept alive--focused on the manner of the proposed death and were often horrified at the idea of causing death by 'starvation and dehydration'. The practical consequence of this can be that people in permanent vegetative state (PVS) and MCS are being administered life-prolonging treatments long after their families have come to believe that the patient would rather be dead. We suggest that medical ethicists concerned about the rights of people in PVS/MCS need to take this empirical data into account in seeking to apply ethical theories to medico-legal realities.

'Kids are just cruel anyway': lesbian and gay parents' talk about homophobic bullying.

Psychologists recognize homophobic bullying as a serious problem for young lesbians and gay men; however, when it comes to children in lesbian and gay households the issue is not so clear cut. Some psychologists sympathetic to lesbian and gay parenting regard it as a problem, but most do not. Despite this, the inevitability and severe psychological consequences of homophobic bullying is a prevalent theme in discussions of lesbian and gay parenting in contexts ranging from custody cases to television talk shows, and is used to implicate lesbians and gay men as unfit to parent. This is the broader context in which lesbian and gay parents discuss their children's experiences of bullying. In this study, we provide a discursive psychological analysis of six lesbian and gay parents' accounts of bullying. We argue that these accounts are discursively and rhetorically designed to deal with a heterosexist social/political context. Lesbian and gay parents face a dilemma of stake and accountability: reports of no bullying risk being heard as implausible given the prevalence of the bullying theme; at the same time, reports of bullying are equally if not more risky, raising the possibility of charges of bad parenting. We explore the detail of the parents' accounts of bullying to illustrate how they are designed to negotiate this web of accountability, and we argue for the importance for critical social psychology of analysing the talk of socially/politically marginalized groups.