The doctors didn't know best

Today's judgment marks an overwhelming rejection of the mentality of "doctor knows best".

In law, it has always been the patient's right to decline treatment. But in this case, doctors who had refused to carry out Miss B's wishes for ethical reasons questioned her mental capacity to make the decision.

Their lawyers had argued that her extreme disability and prolonged stay in a unit for terminally ill patients could have overwhelmed her ability to believe that rehabilitation could make any difference. If the doctors had won they would, in effect, have won the right to override a patient's wishes.

But when she heard the case two weeks ago, judge Dame Elizabeth Butler-Sloss left little doubt that she found such a paternalistic attitude distasteful. She told the lawyers: "You seem to be saying that if you want something and the doctors don't think it is a good idea because they want to do something else, the more you disagree, the more you will be regarded as unable to make a decision.

"That is a very dangerous concept. There is a very paternalistic element. It is a very 'doctor knows best' concept. I really bridle at that as a member of the public as well as a judge."

Although the case has become known as the "rightto-die" ruling, Dame Elizabeth's judgment does not advance arguments for or against euthanasia; it is about the fundamental question of whether individuals have the right to make decisions about their treatment. The case is a landmark one because it is the first time somebody being kept alive on a ventilator has gone to the High Court for their right to refuse treatment.

The decision does not mean Miss B will die imminently - she has agreed to a "cooling-off" period in rehabilitation. But while the doctors directly involved in the case have said they feel unable to switch off her life support, it is understood others working for the same NHS trust have said they would be willing.

An individual who actually switches off the machine will not face prosecution for murder or manslaughter because the law draws a distinction between active and passive euthanasia.

Active euthanasia occurs when treatment is given with the intention of ending a patient's life; passive euthanasia is when treatment keeping a patient alive is withdrawn.