This distasteful term has generated considerable dispute as to its meaning and relevance. It has nothing to do with the concept of civil negligence and should only be used in the narrow sense to mean lack of physical attention, in other words neglect ( R v HM Oo^ ). The Court of
Appeal defined neglect as follows:
a gross failure to provide adequate nourishment or liquid, or provide or procure basic medical attention or shelter or warmth for someone in a dependent position... who cannot provide it for himself. Failure to provide medical attention for a dependent person whose physical condition is such as to show that he obviously needs it may amount to neglect. So it may be if it is the dependent person's mental condition which obviously calls for medical attention.
.neglect can rarely, if ever, be an appropriate verdict on its own.
Despite the apparent relevance of this definition to circumstances where intensive care is withheld or withdrawn, medical practitioners need not fear unduly because the circumstances which prompt 'withhold or withdraw' decisions are those where death from natural causes is considered a virtual certainty in any event. The law seeks to establish not only the cause of death in fact, i.e. which system failed, but also causation in law, i.e. the initiating event in a chain of sequential events which culminates in death. Similarly with the advance directive—this is not to be regarded as a variant of suicide or voluntary assisted euthanasia, but as a natural consequence of a valid autonomous decision.
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