Information Note on the Court’s case-law No. 51
March 2003
Glass v. the United Kingdom (dec.) - 61827/00
Decision 18.3.2003 [Section IV]
Article 8
Article 8-1
Respect for private life
Administration of morphine to critically ill child against family’s wishes: admissible
The first applicant, David Glass, was born in 1986 and is severely mentally and physically disabled and requires twenty-four hour attention. The second applicant is his mother. In July 1998, David became critically ill following an operation. He gradually improved to the point of being able to return home several weeks later. However, his health remained poor and by October he was again critically ill. During this time, the family had indicated their concern at the possibility of David being treated with morphine, which they considered would hasten his death. By 20 October, the medical team were of the view that David was dying of respiratory failure and proposed diamorphine. His mother maintained her opposition, fearing that it would be tantamount to euthanasia. A police officer who was present informed her that if she tried to remove David from the hospital she would be arrested. Similarly, if family members tried to obstruct the doctors, they too would be removed. A diamorphine infusion was commenced that evening. The instruction “Do not resuscitate” was added to David’s file without his mother’s knowledge. The following morning, David’s condition was extremely critical. The situation in the ward degenerated into a physical confrontation between the doctors and family members. The police were called in and the other sick children were moved elsewhere. David’s condition improved to the point where he was able to be taken home that same day. The applicants maintain that no arrangements were made for David’s continuing care, despite his very weak condition. The hospital subsequently advised the family that, in the circumstances, it could no longer treat David and that it had arranged for another hospital to admit him if necessary. A number of relatives were subsequently convicted of assault. The second applicant lodged a complaint against the doctors with the General Medical Council, which decided that the test for bringing disciplinary proceedings was not satisfied on the evidence. She also complained to the police, who referred the matter to the Crown Prosecution Service. The latter decided not to bring charges. The applicant applied for judicial review of the medical decisions made by the hospital but the High Court refused the application on the basis that the situation had passed and that judicial review was too blunt an instrument for the sensitive and ongoing problems that might arise in future. The Court of Appeal, refusing leave to appeal, nonetheless stated that in case of conflict between the family and doctors, the matter must be brought before the courts in order to decide what is in the best interests of the child.
Inadmissible under Article 2: The applicants criticise the doctors’ clinical judgment in administering diamorphine. It is not the function of the Court to gainsay the doctors’ assessment of the first applicant’s condition on 20-21 October 1998. Where a State has made adequate provision for securing high professional standards among health professionals and the protection of lives of patients, an error of medical judgment (even if established) is not sufficient to engage State responsibility under Article 2. The regulatory framework does not disclose any shortcomings and the doctors’ actions were subject to thorough inquiry by the General Medical Council and the police. Although the applicants were critical of the outcome, the Court cannot find fault with the manner in which these investigations were conducted. The issues of the treatment administered and the “Do not resuscitate” notice fall to be examined under Article 8: manifestly ill-founded.
Admissible under Article 8.
Inadmissible under Article 6 § 1: The applicant’s argument that the hospital should have sought a High Court ruling before administering diamorphine against the family’s wishes falls to be considered under Article 8. As for the High Court’s refusal to rule on the legality of the treatment administered, this was understandable in view of the factual dispute over David’s precise condition at the relevant time. With regard to his ongoing treatment, domestic courts must have some degree of flexibility in framing their response to the issues put to them, provided that they do not abdicate the essence of their adjudicative function. The Court of Appeal made a clear statement on the right of the applicants to seek the intervention of the High Court in future: manifestly ill-founded.
Inadmissible under Article 13: The applicants’ arguments under Articles 2 and 6 § 1 were manifestly ill-founded, while with regard to Article 8 the applicants’ right to apply to the High Court had been established: manifestly ill-founded.
Inadmissible under Article 14: The applicants claimed that the hospital had discriminated against David on the basis of his severe disability. Although David’s condition was undoubtedly a relevant factor in deciding how to treat him, it could not be maintained that the doctors were influenced by considerations of his quality of life compared with that of an able-bodied person. Similarly, there was no indication that such considerations played a part in the hospital’s failure to seek a High Court ruling or, subsequently, the domestic courts’ reluctance to address the issues raised by the applicants: manifestly ill-founded.
© Council of Europe/European Court of Human Rights
This summary by the Registry does not bind the Court.
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