The cycle of violence

Doctors must act in accordance with what good medical practice would deem to be in the best interests of the child. This will involve a consideration of the degree of pain and suffering to which the child will be condemned if it continues to live and may require an answer to the question, "What choice would the child make if it were able to make such a choice? " If surgery or other invasive techniques which could be described as "treatment" are not in the best interests of the child, then it is permissible to withdraw, or not to embark upon, such treatment even if the certain consequence is that the child will die from some natural cause.

Conceptually, this is justified by classifying the withdrawal or withholding of treatment as an omission. The enquiry, then, is what duty is imposed on the doctors? The answer, of course, is to act in the best interests of the child, so that there may be no duty to continue treatment, or to embark upon new treatment. Though the point is not absolutely clear, it is unlikely that ordinary feeding would be described as "treatment". Shortening a child's life by withholding from it food and drink which it was capable of ingesting without invasive techniques would probably be unlawful no matter what the child's condition.

Either this is an act of starving to death or it is an omission in circumstances where a duty to act exists. In Re A [2000], the Court of Appeal, quite understandably, refused to classify the separation of conjoined twins as an "omission" to provide treatment. In consequence, however, the Court was forced to work very hard to find reasons to sanction the operation to separate the twins and to ensure that the doctors were not guilty of the murder of the weaker twin, who was bound to die.

Victims in a permanent vegetative state In the very important case, Airedale NHS Trust v Bland [1993], the House of Lords had to face for the first time the issue of the duty on doctors to continue to treat a patient in a persistent vegetative state and for whom there was no prospect of a recovery of any degree of consciousness. V was severely injured when he was crushed in a crowd of football supporters attending an FA Cup semi-final game. By the time resuscitation treatment was administered to him, his brain had been deprived of oxygen for a significant period and the cerebral cortex (the centre of consciousness and all higher functions in the brain) had effectively been destroyed.

However, hisbrain stem functioned normally and he was not dead in any sense recognised by law or medicine. Since he could not swallow, he was fed by means of a tube threaded into his stomach down which food was mechanically pumped. Drugs were administered to suppress infections, and other surgical intervention had been required. The judgments make use of the rules and principles enunciated above, though there was a strong plea from Lords Browne-Wilkinson and Mustill that Parliament should intervene to lay down rules to govern the conduct of doctors in such situations.

It was held that the doctors were under no duty to continue to "treat" V and so wouldnot be guilty of any offences should they cease to do so (V died a short time after treatment stopped). Their Lordships began by arguing that, though the fundamental principle is the sanctity of life, the principle is not absolute. There is no absolute rule that treatment must be given which will prolong life (for instance, the doctor's duty to act in the best interests of his patient must yield to the principle of self-determination – the patient could require life-support to be discontinued). However, it is not lawful to act only for the purpose of bringing about death, even if this is motivated by a desire to end suffering. Importantly, the feeding had to be seen in the context of the whole regime and, especially, the requirement to use an invasive technique (the tube). The feeding could therefore be seen as "treatment", and its cessation as cessation of treatment and not merely as "starving to death".

There are two principal aspects to the debate on battered defendants. The first is whether battering may induce a psychological state, known as battered woman syndrome, which causes battered women to have beliefs and exhibit behaviour different from those of the ordinary non-battered person.

This aspect is important because, while battered woman syndrome is not in itself a defence, evidence about the syndrome has been admitted at criminal trials both to explain the behaviour of battered defendants and to support their claims to one or other of the legal defences. In practice, evidence on "battered woman syndrome" has included expert evidence concerning the psychological, social and economic aspects of domestic violence. This has led to confusion over what the term "battered woman syndrome" means.

In this report we refer to the broader type of expert evidence as "expert evidence on battering relationships" and reserve the term "battered woman syndrome" to refer to the theory advanced by Dr Walker in The Battered Woman Syndrome. 10 BATTERED WOMAN SYNDROME The theory of "battered woman syndrome" is based on the theory of the cycle of violence in battering relationships and the application of the theory of learned helplessness to battered women.

The cycle of violence

According to the cycle of violence theory, battering in domestic relationships is neither random nor constant, but rather occurs in repeated cycles, each having three phases. The first phase is a period of tension building that lead up to the second phase, an acute battering incident. This is followed by the third phase, which consists of kind, loving, contrite behaviour displayed by the batterer to the woman. The third phase provides positive reinforcement for women to remain in the relationship.