Was the use of ‘best interests’ in the case below of Tony Bland appropriate?
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The concept of ‘best interests’ is often invoked to morally justify making decisions for those who are temporarily or permanently unable to exercise autonomy. Legally, the concept of best interest will ordinarily apply in emergency, life-threatening situations where a patient is unable to give consent to treatment. ‘Best interests’ is one of the basic principles of the Mental Capacity Act (2005), which states that: “An act done, or decision made, under this Act for or on behalf of a person who lacks capacity must be done, or made, in his best interests” (Section 1 (5)). Check some of the documents here (SCIE 2017) and then consider the following case: Airedale NHS Trust v Bland (1993) AC 789 HL applied the concept of ‘best interests’ in support of the withdrawal of treatment from a man in a persistent vegetative state. Tony Bland was a victim of the 1989 Hillsborough Football Stadium disaster, and medical evidence was unanimous that there was no prospect whatsoever of him ever making any recovery from his persistent vegetative state. With the agreement of his parents, the NHS Trust applied to the High Court for declarations that life-sustaining treatment (including feeding and hydration) could lawfully be discontinued and that any further medical treatment would be for the sole purpose of enabling Mr Bland to die peacefully and with dignity. The High Court agreed but the Official Solicitor, acting on behalf of Tony Bland, appealed against the decision, arguing that withholding feeding was equivalent to starving the patient to death (and thus amounted to murder or manslaughter). The case was eventually decided by the House of Lords, who accepted the majority view of the medical profession that artificial feeding and hydration could be regarded as a form of medical treatment. Treatment could be withdrawn, they stated, when its continuance was no longer in the best interests of the patient. Therefore, Tony Bland’s treatment (including feeding and hydration) could be lawfully discontinued in order to allow him to die. In this case, the question was not whether it was in Mr Bland’s best interests to die, but whether it was in his best interests to have his life prolonged by the continued provision of medical treatment. However, it is arguable whether Tony Bland actually had ‘best interests’, as he was insensate. A counter-argument is that one does not necessarily have to be aware of interests for them to be morally relevant, and therefore respect for an insensate individual should (and does) persist both prior to and following death.

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