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Should someone in a vegetative state, with no awareness of themselves or what is going on around them, be kept alive with a feeding tube for years after all hope of recovery has gone? It’s a question not many want to think about, but some families have to.

Now, a announced yesterday by the Court of Protection of England and Wales may make it easier for families of people in such conditions to stop artificial feeding and let their loved one die without having to go through a lengthy and distressing legal process.

It might seem like this could allow significant decisions to be made too easily, or even that the court is legalising a form of euthanasia. In fact, this change is long overdue, and is in line with other Western countries, such as the US and Australia.

The ruling concerns people who are left in a permanent vegetative or minimally conscious state, usually after they have received a brain injury and emerged from a coma into a state where they can breathe unaided but have almost no sign of awareness. They would die if they didn’t have a feeding tube providing nutrients and fluid.

Once it is clear that someone’s condition is permanent, many families agree with doctors that their relative shouldn’t be given any medical treatments that could prolong their life. These might include antibiotics, or resuscitation if their heart stops. Often the patients die after a few years from pneumonia or other infections, but some can live for decades.

Costly legal action

Until now, though, a judge’s approval was needed to remove someone’s feeding tube – even if the family and doctors agreed it was in the patient’s best interests. Most families are put off by that prospect, as the legal process can take many months or even years, cost them tens of thousands of pounds, and the environment can make them feel like they are doing something hostile to their loved one.

There are thought to have been only about 100 such court cases in the UK over the past two decades, says at the , though no central records are kept. This is against up to an estimated 16,000 people thought to be in a permanent vegetative state in the UK, plus about three times that number in a minimally conscious state.

We are better than ever at saving the lives of people with devastating brain injuries, but if recovery is incomplete, this leaves more people and their families in the most horrible kind of limbo. Doctors in countries such as the Netherlands, where there are only a few tens of people in a permanent vegetative state, regard what goes on in the UK with horror, seeing it as a form of mass torture, says Kitzinger.

When a feeding tube is removed, the patient can take around two weeks to die from organ failure caused by dehydration, during which time they are given pain relief and heavy sedation. It’s no worse than letting someone die from pneumonia, says Kitzinger, which can be distressing for the family as the patient’s breathing becomes laboured and choking.

The previous legal guidance in England and Wales – that for these patients feeding tubes are unique as a medical treatment that can only be removed by court order – has long been criticised. The ruling announced yesterday could be appealed, but if it stands we can welcome the fact that doctors and families will be able to make this hard decision without referring to the courts.

A resource for families of people with such a medical condition can be found at