Doctors must continue the treatment of a brain-damaged man with kidney failure, the Court of Protection has ruled.
In Re P the patient was now in his 40s. He had been born with kidney problems but these did not begin to affect his health in a significant way until he reached his 30s. The man required regular kidney dialysis but was very unhappy about this. He extensively researched alternative treatments like transplant and did not attend for treatment as often as doctors recommended.
Mr Justice Newton explained:
“He clearly investigated every alternative and was very anxious about the experiences of the patients at the various medical institutions. He considered the circumstances to be far from hygienic, he was aware that patients were frequently exhausted and considered the whole process deeply undignified.”
Then in November last year, the man, referred to as ‘P’, suffered a heart attack. Circulation was not restored for 25 minutes, by which time P had suffered significant brain damage. He has been unconscious since then and confined to an intensive care unit.
The NHS Trust treating him applied for a declaration that he lacked capacity; that it would not be in his best interests to be resuscitated if he suffered a further heart attack; and that it would be lawful to cease his kidney dialysis.
Mr Justice Newton described the first two declarations as “uncontentious”. Doctors agreed that he would never regain capacity. They believed him to be in a ‘permanent vegetative state’, while P’s family, by contrast, took an opposing view. They insisted that he was actually in a less severe ‘minimally conscious state’ and regularly responded to them in a meaningful way. Discontinuing treatment would go against both his personal and religious views and would not be in his best interests, they argued.
The Judge said:
“I have found the increasingly polarised view of the [doctors and the family] profoundly troubling. The family have always properly and steadfastly maintained and argued their position. But for their politely and cogently articulated stance, it may well have been that renal replacement therapy would have been stopped, and P would already no longer be alive. They endeavoured to support their efforts by the taking of video recordings of occasions when they said that P had responded to verbal communication.”
In a careful and detailed ruling, Mr Justice Newton considered the nature of the treatment and whether or not it placed too great a burden on P. He noted the views expressed by P before his heart attack. He was opposed to euthanasia and was a “deeply religious” Sunni Muslim who believed that only God could take away life.
The Judge noted:
“… he believed that suffering was a component of predestination and someone else should not play an assisting role in shortening life merely because of the subjective quality of that life. It is against the tenet of his faith to do anything to shorten a life.”
Mr Justice Newton concluded that:
“I have reached the clear conclusion that the balance lies strongly in favour of preserving P’s life through the continued provision of [treatment].”
P did not appear to be in pain or discomfort.
Read the ruling here.
