The Court of Protection recently considered an application by London North West University Healthcare NHS Trust (the Trust) for a declaration that it was lawful and in the best interests of the Protected Party (M) to be put on the palliative care pathway and for all artificial life-prolonging treatment to be stopped.
The Protected Party is a 23-year-old man, who was described as fit and well prior to the beginning of the pandemic.
In March 2020, the Protected Party was initially furloughed and then made redundant from his job as a computer engineer. Around the same time, the Protected Party was found to have high levels of glucose and ketones in his urine. These symptoms were suggestive of type 1 diabetes but the Protected Party refused to go to the hospital for further investigation and treatment as he was worried about contracting Covid-19.
On 5 November 2021, the Protected Party sadly suffered a cardiac arrest at home and was placed into an induced coma. In the hospital, the Protected Party was diagnosed with type 1 diabetes and in a bid to try and control his unstable condition was fed via a nasogastric tube.
Scans showed that the Protected Party had suffered a hypoxic brain injury and damage to his liver. His condition deteriorated and following review, his medical team concluded that he should be registered as Do Not Resuscitate (DNR).
The Protected Party was then moved to a rehabilitation unit where his condition deteriorated further. His treating clinicians concluded that they could no longer provide the Protected Party with tube feeding, or total parenteral nutrition (TPN), as he had developed an ileus (a condition where the gut ceases to propel food along the intestine). The clinicians were of the view that the Protected Party should be moved to palliative care which would involve the sedated withdrawal of all treatment.
The Protected Party’s family objected to this decision and so the Trust made an application to the Court of Protection. In making a decision, the Judge considered a plethora of evidence from numerous medical experts and the Protected Party’s family.
The Protected Party’s family hoped that he would be able to recover and with further investigation, would be given the chance to live. The Protected Party’s family objected to him being placed on palliative care and requested the Court to order that treatment and nutrition be continued in some form.
The family suggested that the clinical team was not being completely transparent about the Protected Party’s condition and had malign motives. The Protected Party’s mother (A) was of the view that the Trust did not care for the Protected Party’s best interests, wished to euthanise the Protected Party, and had a vested interest in the Protected Party not surviving.
In summary, the clinicians opined that:
- To provide the Protected Party with nutrition, hydration or any other active treatment would be medically ineffective and likely cause serious complications. TPN would put the Protected Party at serious risk of infection and tube feeding would actively shorten his life.
- Whilst hydration may have lengthened the Protected Party’s life slightly, this would not make him more comfortable.
- The Protected Party was “gradually fading” and was deemed to be in a vegetative state. If the Protected Party were to be moved to another unit for treatment, it was more likely than not that he would die in the ambulance.
- The Protected Party’s life expectancy was deemed to be limited to a few weeks at most and it was not morally acceptable to continue to deprive the Protected Party of good palliative care.
- It could not be in the Protected Party’s interests to perpetuate a life of permanent disordered consciousness by continuing treatments that had no clinical nor moral value.
It was clear that all of the doctors held the same views in respect of (1) the Protected Party’s condition and (2) the unsuitability of continuing with life-prolonging treatment.
In making a decision, the Court was required to determine what was in the Protected Party’s best interests in accordance with Section 4 of the Mental Capacity Act 2005 (MCA) and based on the limited options available to the Protected Party.
The Judge described the medical evidence in this case as “unanimous, compelling and overwhelming” and concluded that whilst continuing treatment would prolong the Protected Party’s life by a few weeks only, it would not improve the Protected Party’s quality of life.
The Judge, therefore, found that it was in the Protected Party’s best interests to receive tailored palliative care and granted the declarations applied for by the Trust. Sadly, the Protected Party passed away before the care plan could be put into action.
In this case, the Judge had the difficult task of balancing the medical evidence with the strong views held by the Protected Party’s family, whilst primarily determining what was in the Protected Party’s best interests in the widest possible sense.
Whilst all reasonable steps should be taken to prolong the life of a patient, it is of utmost importance that such steps must always be in a person’s best interests. This was found not to be the case for the Protected Party. There are a limited number of cases where life-prolonging treatment will be deemed to be overly burdensome to the patient and will most likely be the case where there is no real prospect of recovery.
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