In light of the cases that are coming before the Court of Protection about the dividing line between treatments which are clinically inappropriate (and hence are not on the table), and treatments which are not in the person’s best interests (and hence are in principle on the table), Medmoune v France [2026] ECHR 27, is of no little importance as the latest Strasbourg word on the position. The judgment is in French (the translations below are informal ones via Google Translate), but concerned a patient who had sought to make an advance directive seeking (in effect) to be kept alive at all costs; in this he was supported by his family. After he had lost capacity following a serious road traffic accident, the medical professionals considered (in effect) that life sustaining treatment was no longer clinically appropriate, and sought to withdraw it in line with the relevant French law.
The ECtHR noted in its judgment that:
48. Furthermore, the Court points out that, in the case of the cessation of treatment which artificially sustains life, reference must be made, in the context of the examination of a possible violation of Article 2, to Article 8 of the Convention (see Lambert and Others, cited above, § 142). However, it has held that, while Article 8 guarantees the right to personal autonomy as an element of the right to respect for private life, it does not oblige the Member States to confer binding legal effect on advance directives (see Lindholm and the Estate after Leif Lindholm v. Denmark, no. 25636/22, § 86, 5 November 2024), this question falls within their discretion (Pindo Mulla v. Spain[GC], no. 15541/20, § 153, 17 September 2024). Furthermore, the Council of Europe’s guide “on the decision-making process relating to medical treatment in end-of-life situations”, which should be taken into account (see Lambert and Others, cited above, § 143), states that “autonomy does not imply a right for the patient to receive any treatment that he/she may request, in particular when the treatment concerned is considered inappropriate[, since] the decision in the field of health care is the result of the meeting of the patient’s will and the assessment of the situation by a professional subject to his professional obligations and, in particular, those arising from the principles of beneficence and non-maleficence, as well as justice”.
The ECtHR found the relevant French law to comply, in the abstract, with the requirements of Article 2 ECHR. As regards the specific circumstances of the case, the ECtHR was satisfied that the patient’s wishes had been at the centre of the decision-making process, and the views of the family had been appropriately taken into account (see paragraphs 53 and 54), such that “the medical team took into account the family’s opposition to the cessation of care, but considered that, while it could understand it on a human level, it could not endorse it from a medical point of view.” The court was also satisfied that there had been appropriate mechanisms by which the family could seek to challenge the decision (nb, in England & Wales, and for the reasons set out here, that route is not the Court of Protection if the decision is that treatment is not clinically appropriate). The court appeared to be satisfied that this was a route which was to be used by a person challenging the medical decision – in other words, it did not make any observations about disputes needing to be placed before the domestic courts by the treating body; rather, it was the existence of a potential route of challenge which was important. It was also satisfied that, in the instant case, that route of challenge, once invoked by the family, had been operated appropriately. It therefore found that the patient’s rights under Article 2 ECHR had not been violated.
