A coroner's finding of 'unlawful killing' covers all cases of homicide but requires proof to the criminal standard of 'beyond reasonable doubt'. Concerns that decisions to withhold or withdraw intensive care could lead to such a finding are misplaced in the majority of cases. Whatever the factual cause of death, causation in law is likely to be the initiating illness which created the need for intensive care. Special considerations apply to patients who require support of basic biological functions such as nutrition and hydration but whose condition is otherwise stable, a question usually discussed in the context of persistent vegetative state ( Aiie.d§l§,,,N HSTrust v Bland,). Here it is more difficult to distinguish causation in fact and in law, and the current position is that application be made to the courts for a ruling that the withdrawal of treatment in an individual case would not be unlawful ( House,of Lords,,,1994). It is important to note that the coroner is not empowered to make such a ruling, nor can criticism or even the potential for prosecution be avoided by informing the coroner in advance of an intention to withdraw supportive management from a patient in this condition. It is to be hoped that the current requirement for judicial approval will soon be replaced by accepted guidelines, analogous to the criteria for brainstem death.
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