BACKGROUND In the ruling in Y [2018], the UK Supreme Court has confirmed that there is no general requirement for the courts in England and Wales to authorise the withdrawal of clinically assisted nutrition and hydration from patients with prolonged disorders of consciousness. The perceived requirement, which originated in a court ruling in 1993, encompassed those in the vegetative state and those in the minimally conscious state. The ruling in Y confirms that the court may still be approached to decide difficult or contested cases, but there is otherwise no routine requirement that the judges be approached. MAIN BODY There is much to welcome in this ruling, particularly as it means that these decisions for these patients are no longer (unusually) singled out for a judicial decision, with all the financial and emotional costs that court proceedings can entail. However, there is also a risk that the ruling might have unwelcome consequences. First, there is the possibility that patients might die too soon, particularly if doctors should now adopt the courts' previous reasoning, which has suggested that patients in the vegetative state lack interests, so treatment may - perhaps must - be withdrawn. Secondly, there is the converse possibility that patients might live too long, since empirical research suggests that - whether intentionally or not - patients' families, clinicians, and the health system appear to promote treatment-by-default. CONCLUSION Rather than adopt general positions, which may be contestable and potentially risky, this article argues, on a pluralistic basis, that the individual patient should be the focus of any decision made in his or her 'best interests'. The existing legal framework in England and Wales, which is provided by the Mental Capacity Act 2005, already points in this direction, although more efforts may be needed to ensure that those involved in making these decisions are suitably educated and supported. Fortunately, new guidance from the British Medical Association could help clinicians and families to make decisions in the future, which are appropriate for the incapacitated individual patient in question.

中文翻译：

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死得太早还是活得太久？ Re Y 后长期意识障碍的患者停止治疗。


背景 在 Y [2018] 案的裁决中，英国最高法院确认，英格兰和威尔士法院没有一般要求授权撤销对长期意识障碍患者的临床辅助营养和水合作用。这一感知要求起源于 1993 年的一项法院裁决，涵盖了植物人状态和最低意识状态的人。 Y 案的裁决确认，仍然可以联系法院来裁决疑难或有争议的案件，但没有常规要求联系法官。主体 这项裁决有很多值得欢迎的地方，特别是因为它意味着这些针对这些患者的决定不再（不寻常地）被单独单独做出司法决定，而法庭诉讼可能会带来所有的经济和情感成本。然而，该裁决也存在产生不良后果的风险。首先，患者有可能过早死亡，特别是如果医生现在采纳法院先前的推理，即植物人状态下的患者缺乏兴趣，因此治疗可能（也许必须）被撤回。其次，存在一种相反的可能性，即患者可能活得太长，因为实证研究表明，无论有意还是无意，患者的家人、临床医生和卫生系统似乎都在提倡默认治疗。结论 本文认为，在多元化的基础上，个体患者应该成为为他或她的“最佳利益”做出的任何决策的焦点，而不是采取可能存在争议和潜在风险的一般立场。 英格兰和威尔士现有的法律框架（2005 年《心理能力法》）已经指出了这个方向，尽管可能需要付出更多努力来确保参与决策的人员得到适当的教育和支持。幸运的是，英国医学协会的新指南可以帮助临床医生和家庭在未来做出适合个别失能患者的决定。