Withdrawal of Clinically Assisted Nutrition and Hydration for a Patient in a Persistent Vegetative State: A Report of a Case in the UK With Cross-Jurisdictional and Islamic Law Perspectives.

The withdrawal of clinically assisted nutrition and hydration (CANH) is a legally and ethically complex intervention governed by distinct frameworks across the world. In the UK, the British Medical Association (BMA) and Royal College of Physicians (RCP) guideline on CANH, formulated in 2018 after a Supreme Court ruling, provides a framework for decisions. In contrast, Islamic law treats nutritional support as basic care, and its withdrawal is prohibited unless it causes direct harm or there is the presence of an advance directive. Cross-jurisdictional cases where a patient moves between these legal frameworks are rarely described in published literature. We report the case of a 61-year-old woman with no co-morbidities who was in Qatar in November 2024 when she had an out-of-hospital cardiac arrest, resulting in a hypoxic brain injury and later a persistent vegetative state. Her family requested withdrawal of care, citing her wishes to avoid living with a disability. The hospital consulted its ethical and legal departments and concluded that they could not withdraw nutrition as there was no prior explicit directive from the patient. She was repatriated to her local hospital in the UK after eight weeks. She remained in a vegetative state, and her brain imaging was unchanged. Her care team followed the BMA/RCP CANH 2024 guidelines to assist with the process of withdrawing nutrition and hydration and obtained further specialist and legal team opinions. Letters of support from family and friends were also collected. Supportive treatment was withdrawn nine days after UK repatriation, and she died three weeks later with palliative team input. This case illustrates the practical challenges of applying CANH withdrawal guidelines across jurisdictions with different legal and ethical frameworks. It demonstrates the importance of a robust, workable framework like the BMA/RCP guideline on withdrawal of CANH. It highlights the value of advance directives, close family involvement, and legal framework in clinical decisions. Clinicians caring for Muslim patients should be aware of the Islamic bioethical perspective on CANH, which may shape family expectations and discussions in similar situations.