1. Airedale NHS Trust v Bland (UK House of Lords, 1993)

Facts

• Tony Bland was a victim of the Hillsborough disaster.
• He suffered severe brain damage and entered a persistent vegetative state (PVS).
• He could breathe without a ventilator but could not eat or drink normally.
• He was maintained on artificial nutrition and hydration (ANH) via tube feeding.

Legal Issue

Whether doctors could lawfully withdraw tube feeding, knowing it would lead to death.

Decision

The House of Lords allowed withdrawal of feeding.

Key Legal Principles

• Tube feeding is classified as medical treatment, not basic care.
• If treatment provides no therapeutic benefit, it may be withdrawn.
• Withdrawal is lawful if it is in the patient’s best interests.
• The court distinguished between:
  • Killing a patient (illegal)
  • Allowing nature to take its course (lawful when treatment is futile)

Significance

• First major UK case recognizing withdrawal of artificial feeding in PVS patients.
• Established that continuing feeding is not always mandatory even if it causes death when stopped.

2. In re Quinlan (New Jersey Supreme Court, 1976, USA)

Facts

• Karen Quinlan was in a coma-like persistent vegetative state.
• She was kept alive using mechanical ventilation and tube feeding.
• Her father requested removal of life support.

Legal Issue

Whether life support (including feeding) could be withdrawn without violating homicide laws.

Decision

The court allowed withdrawal of life support.

Key Principles

• Recognized a constitutional right to privacy, which includes refusing medical treatment.
• Even though Karen could not consent, her guardian could exercise substituted judgment.
• Doctors acting in good faith to withdraw treatment would not face criminal liability.

Significance

• One of the earliest cases establishing the right to refuse artificial life-sustaining treatment, including feeding.
• Strong influence on later US end-of-life law.

3. Cruzan v Director, Missouri Department of Health (US Supreme Court, 1990)

Facts

• Nancy Cruzan was in a persistent vegetative state after a car accident.
• She was sustained by a feeding tube.
• Her parents requested withdrawal of tube feeding.

Legal Issue

Whether the state could require “clear and convincing evidence” of patient wishes before stopping feeding.

Decision

The Supreme Court upheld Missouri’s requirement.

Key Principles

• Competent individuals have a constitutional right to refuse medical treatment, including artificial feeding.
• However, states may require strong evidence of prior wishes for incompetent patients.
• Emphasized importance of advance directives (living wills).

Significance

• Reinforced that enteral feeding is legally “medical treatment” that can be refused.
• Strengthened legal importance of documenting consent in advance.

4. Schiavo Case (Terri Schiavo, Florida Courts & US Supreme Court involvement, 2005)

Facts

• Terri Schiavo was in a persistent vegetative state for years.
• She was sustained by a PEG feeding tube.
• Husband claimed she would not have wanted artificial life support.
• Parents disagreed, arguing she should be kept alive.

Legal Issue

Whether feeding tube could be removed based on alleged prior wishes.

Decision

Courts authorized removal of the feeding tube after extensive litigation.

Key Principles

• Court relied heavily on substituted judgment standard.
• Evidence of patient’s wishes (even oral statements) can be decisive.
• Family disputes do not override legal determination of best interests or prior wishes.

Significance

• Highlighted ethical and legal conflict in enteral feeding withdrawal cases.
• Showed importance of advance directives to avoid prolonged litigation.
• Demonstrated that feeding tubes are legally removable life-sustaining treatment.

5. Re B (Adult: Refusal of Medical Treatment), UK High Court 2002

Facts

• A competent adult patient suffered a severe spinal condition.
• She required mechanical ventilation and artificial nutrition.
• She was mentally competent but physically paralyzed.
• She refused continuation of life support, including feeding.

Legal Issue

Whether doctors must continue treatment against a competent patient’s wishes.

Decision

Court upheld her right to refuse treatment.

Key Principles

• A competent adult has an absolute right to refuse medical treatment, even if it results in death.
• Consent is not required for refusal; capacity is the key factor.
• Medical professionals must respect refusal unless capacity is impaired.

Significance

• Reinforces strongest principle in consent law: bodily autonomy overrides medical opinion.
• Applies directly to enteral feeding refusal in competent patients (e.g., refusing PEG tube).

Core Legal Principles from These Cases

Across jurisdictions, the law on enteral feeding consent is built on these ideas:

1. Enteral feeding is medical treatment

• Not basic care → requires consent or lawful justification.

2. Competent refusal is absolute

• A mentally capable patient can refuse feeding even if it causes death.

3. Incompetent patients → best interests test

• Courts decide whether feeding is beneficial or futile.

4. Withdrawal vs withholding is legally similar

• Ethically debated, but legally both can be permissible.

5. Advance directives are crucial

• Written wishes strongly influence outcomes (Cruzan, Schiavo).

Conclusion

Enteral feeding consent law is primarily governed by the balance between:

• Autonomy (right to refuse treatment)
• Sanctity of life (duty to preserve life)
• Best interests (for incapacitated patients)

Cases like Bland, Quinlan, Cruzan, Schiavo, and Re B collectively establish that:

Artificial nutrition and hydration can be refused or withdrawn if lawful consent principles are met, but cannot be removed arbitrarily without strict legal safeguards.