I’ve written here on several previous occasions about the extremely difficult decisions with which our family judges are regularly faced. As I mentioned in this post, sometimes those decisions are literally a matter of life and death.
As it was in the recent Court of Protection case Re O (Withdrawal of Medical Treatment). The case concerned a fifty-eight year old woman who had worked most of her life for the National Health Service as a phlebotomist (blood sample specialist) and as a carer. On the 16th of February 2015 she suffered a cardiac arrest and was admitted to hospital, where she was found to have suffered a severe brain injury.
The woman then spent the following year either in hospital or a nursing home. Sadly, on the 11th of February 2016 she suffered another cardiac arrest and was re-admitted to hospital. On the 16th of March she was examined by a Consultant Neurologist, Dr Moran, who noted that she remained dependent on ventilation, despite having been off sedation or any anaesthetic medication for what was by that time several weeks. Further:
“On neurological examination, there were no voluntary movements and no response to pain. There was frequent posturing. There was spasticity in the upper limbs, entirely flaccid muscle tone in the lower limbs. There were no spontaneous eye movements and no ocular reflex. The pupils did not respond to light. There was no gag reflex. There was no jerking of the jaw. Dr Moran made a diagnosis of “very severe global cerebral cortical damage”.”
Subsequent to this the treating clinicians concluded that it was no longer in the woman’s interests to continue her life by ventilation, artificially, in the way that was taking place. The NHS Trust therefore made an application to the Court of Protection seeking a declaration that their staff might lawfully withdraw and withhold mechanical ventilation and, further, that they might lawfully withhold any escalation of treatment such as cardiopulmonary resuscitation, organ support, or antibiotics.
The application went before Mr Justice Hayden. By this time, as he said:
“…there was a compelling consensus of very distinguished medical evidence concluding that the damage to [the woman’s] brain was so profound that there could be no feeling that there was in reality no sentient life and no prospect of a recovery. Her situation following that second heart attack was markedly different to that following the first heart attack, the brain and brain stem having both been substantially damaged.”
Despite this bleak prognosis the woman’s family desperately wanted her treatment to continue, and sought the opinion of a further expert. This was authorised by Mr Justice Hayden, but unsurprisingly the expert agreed with the earlier medical opinion, and concluded that it would no longer be in the woman’s best interests to keep her on ventilation.
Mr Justice Hayden went further, saying that he considered it would now be inimical to the woman’s welfare to sustain her artificially in such circumstances. He pointed out that there is a strong presumption in favour of life saving treatment. However:
“The Courts must not pursue the principle of respect for life to the point where life has become empty of real content or to a degree where the principle eclipses or overwhelms other competing rights of the patient i.e. in this case simple respect for her dignity.”
Accordingly, he granted the declaration sought by the Trust.
The full judgment in Re O can be read here.
Photo by joeflintham via Flickr under a Creative Commons licence