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Trust wins treatment intervention ruling

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A health trust has won a court ruling that medical staff do not have to forcibly give a seriously ill man the life-prolonging treatment he is resisting.

The decision was made by a judge at the Court of Protection in London in the “desperately sad” case of a 42-year-old hospital patient who does not have the mental capacity to make decisions about his medical care.

As well as suffering from a genetic disorder and learning disability, he also has “multiple” physical illnesses. He is obese and has a needle phobia.

The man, who cannot be named for legal reasons but is referred to as HH, is described as being in the “pre-terminal phase” of multiple organ dysfunction.

Mrs Justice Pauffley granted a declaration sought by the foundation trust responsible for the man’s health care that he “lacks capacity” to make decisions in relation to the “serious medical treatment at issue in this application”.

She further granted a declaration that it would be lawful and in his “best interests” for the trust’s clinicians not to provide any assessments and treatments for his medical conditions “with which he does not comply” where those treatments cannot be delivered “without his co-operation or without the use of physical force”.

The judge said this was “provided that all reasonable steps have been taken to gain his co-operation through the use of appropriate verbal explanations and persuasion, including where appropriate, involving his mother or such other person as she might suggest in attempts to persuade him to accept the said interventions”.

She further declared that it would also be lawful for the man, who is from the south of England, to be provided with “such treatment, including palliative treatment and care, as can be delivered without the use of physical force” to ensure that he suffers the “least discomfort and retains the greatest dignity until such time as his life comes to an end”.

Giving her decision, Mrs Justice Pauffley said the official solicitor, who represents the interests of the patient, and his mother, supported the application made by the trust, which also cannot be named.

She said she was “profoundly moved” by a letter written by the man’s mother which made “very poignant reading”.

The judge announced: “I am entirely satisfied that the application made by the NHS Foundation Trust is well-founded on the basis of the medical evidence.”

She added: “This court is confronted with a desperately sad situation, but to my mind there is no other course open to me when I consider his welfare needs than to accede to the application sensitively and appropriately made by the foundation trust.”

The judge said that “everything that can be done should be done” to promote his dignity during his life that “seems to be fast approaching its final phase”.

She added: “It would be not only inappropriate, it would be distressing for him to be subjected to any aggressive forms of treatment of a kind that may result in some short prolongation of what has to be seen as a distressing life.”

During the hearing, she was told by Bridget Dolan, counsel for the trust, that it was not a case where there was a cure or life-saving treatment, but it concerned the issue of interventions which may prolong his life.

Because of his refusal it was anticipated that his life would be measured in weeks or months.

She told the judge that his “dedicated” mother had not attended court today because she wished to be with her son.

  • 4 Comments

Readers' comments (4)

  • Juggling Dog

    There seem to be a series of recent rulings, which together are making a clear distinction between whether it would be clinically possible to extend the lives of patients, and if 'you felt the experience from the patient's position' would the experience be good or bad.

    They seem to hinge on, for mentally incapable patients, 'If you are only prolonging distress, then you should not be doing that' - in my opinion the correct position, but Trusts seem very nervous about this, still.

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  • perhaps primum non nocere

    should be extended to include

    create no misery as this does not

    seem to be implicit in the word

    'harm'



    "Non-maleficence,

    which is derived from the maxim, is one of the principal precepts of medical ethics that all medical students are taught in medical school and is a fundamental principle for emergency medical services around the world. Another way to state it is that "given an existing problem, it may be better not to do something, or even to do nothing, than to risk causing more harm than good." It reminds the physician and other health care providers that they must consider the possible harm that any intervention might do. It is invoked when debating the use of an intervention that carries an obvious risk of harm but a less certain chance of benefit."

    http://en.wikipedia.org/wiki/Primum_non_nocere

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  • King Vulture

    Anonymous | 26-Aug-2012 8:01 am

    '"Non-maleficence,

    which is derived from the maxim, is one of the principal precepts of medical ethics that all medical students are taught in medical school and is a fundamental principle for emergency medical services around the world. Another way to state it is that "given an existing problem, it may be better not to do something, or even to do nothing, than to risk causing more harm than good."'

    Unless you are a paramedic - active intervention is very much the approach, of ASs.

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  • michael stone

    I hope that this series of recent court rulings, will lead to a better understanding of the right of a mentally-capable patient to refuse anticipated treatments, which the patient has considered in advance of probable (or, for CPR, inevitable) mental incapacity. At the moment, many clinicians hold beliefs that are logically inconsistent, and are also inconsistent with the principle of Considered Refusal.

    And, as the previous post points out, for patients who are nearing the end of their lives at home, the way paramedics behave is often a crucial factor.

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