Mental Capacity and refusal of medical treatment
The Court of Protection has been asked by Kings College Hospital NHS Trust to rule on whether a 50 year old woman, who was refusing life saving medical treatment had mental capacity to make this decision.
The medical team treating her were concerned that she was mentally disturbed and that this impacted on her ability to make decisions and felt that she lacked the capacity to do but the Judge disagreed with them and upheld the patient’s right to refuse medical treatment.
The case has been widely reported in the press but turns on unusual facts. The patient, who was used to a glamorous lifestyle and feared the passing of her youth and beauty had previously made an unsuccessful suicide attempt following a diagnosis of breast cancer. That had led to irreversible kidney damage. However, it was expected that this could be treated by dialysis.
The potential for successful life saving treatment was an important issue and because the doctors felt that there was a good prospect that the patient might return to a relatively normal life, they were concerned as to whether she had a Psychiatric impairment which might be affecting her ability to make this decision, such that she lacked capacity. The Court therefore had to consider evidence from Psychiatrists as well as other family members.
Mr Justice MacDonald made it clear that at the heart of the case, he had to bear in mind the following:
“…the fact that a decision not to have life saving medical treatment may be considered an unwise decision and may have a fatal outcome is not of itself evidence of a lack of capacity to take that decision, notwithstanding that other members of society may consider such a decision unreasonable, illogical or even immoral…”
In his judgment, Mr Justice MacDonald held:
“The right to refuse treatment extends to declining treatment that would, if administered, save the life of the patient.
This position reflects the value that society places on personal autonomy in matter of medical treatment and the very long established right of the patient to choose to accept or refuse medical treatment from his or her doctor.
Where a patient refuses life-saving treatment the court is only entitled to intervene in circumstances where the Court is satisfied that the patient does not have the mental capacity to decide whether or not to accept or refuse such treatment.”
This case is unusual compared with others where withdrawal of medical treatment is concerned. The Court had to consider the very direct and forceful views of the patient against background information from her family, evidence regarding her mental state from independent experts and how this fitted with the legal position and provisions of the Mental Capacity Act.
These cases are unusual but it is important that the Courts recognise the individual circumstances as the Judge did here. Sadly following the decision the patient died.
This case highlights the importance of capacity in decision making and should be read in conjunction with another recent case about the withdrawal of treatment. In Wye Valley NHS Trust v B  EWCOP 60 Mr Justice Peter Jackson held that treatment should be withdrawn where B lacked the capacity to make the decision as it would:
“…not be in Mr B’s best interests to take away his little remaining independence and dignity in order to replace it with a future for which he understandably has no appetite and which could only be achieved after a traumatic and uncertain struggle that he and no one else would have to endure. There is a difference between fighting on someone’s behalf and just fighting them.”
Both patients were in a position where NHS Trusts wished to give them life sustaining treatment. However on both occasions, it was held that this was not appropriate and it is a reminder that there are always individuals at the heart of these cases and that ultimately, their wishes and feelings must be taken into account – no matter what the opinions of others.
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