Who has the right to decide whether a patient's quality of life is too poor to warrant life-prolonging treatment?
That question will be put to three appeal court judges today in one of the most important right-to-life appeals to come before the English courts in recent years.
The judges, headed by the master of the rolls, Lord Phillips, will have to decide where the line is drawn between patients' autonomy and doctors' duty to act in what they believe is their patients' best interests.
The General Medical Council is appealing against a high court ruling last July that its guidance to doctors on the withholding and withdrawing of life-prolonging treatment is unlawful in some respects and breaches human rights.
That ruling was won by Leslie Burke, who has a progressive degenerative disease which, while leaving him fully sentient, will eventually deprive him of the power to feed himself.
Mr Burke, 45, from Lancaster, who has cerebellar ataxia, took the case to court because he feared that when the time came doctors would decide his quality of life was insufficient to warrant prolonging it.
He feared reaching the point where, unable to communicate, he would be denied food and water and would take two to three weeks to die of starvation or thirst.
The case is seen as so important that the health secretary, Patricia Hewitt, the Disability Rights Commission, the official solicitor, the Catholic Bishops Conference for England and Wales, Patient Concern, Medical Ethics Alliance, Alert - Defending Vulnerable People's Right to Live, and the British section of the World Federation of Doctors Who Respect Human Life have all been granted permission to make submissions to the court.
Mr Justice Munby, who delivered the high court judgment, ruled that the GMC guidance laid too much emphasis on the right of a patient to refuse treatment, and not enough on the patient's right to require treatment.
He said it should be for patients, not doctors, to decide what was in their best interests, and that there should be a presumption in favour of prolonging life.
Where patients were unable to take their own decisions, the touchstone for deciding whether it was in their best interests to withdraw treatment was whether the life which would be prolonged was "intolerable".
The guidance, the judge said, was also deficient because it failed to ensure that where a patient wanted artificial feeding but the doctor was against it, the doctor continued treating the patient until another could take over. It also did not make clear that doubtful or disputed cases should be referred to the court.
The GMC and the health secretary argue that the high court judgment would give patients a right to demand the treatment of their choice, and could force doctors to provide treatment they believed was not in the patient's best interests.
But the Disability Rights Commission maintains that this is a misinterpretation. A spokesman said: "The judgment upheld the right of doctors to make clinical decisions and they will not be forced to provide futile treatment or treatment of no, or detrimental, benefit. The important thing is that patients can decide what is in their best interests."
The GMC said: "Doctors want clear guidance to help ensure individual patients receive the care that's right for them. This is why we are appealing the judgment."
