A recent decision highlights the Court’s approach to balancing autonomy and medical necessity.
The case concerned LE, a 46-year-old woman with schizophrenia and diabetes, who developed severe dry gangrene in the fingers and toes following complications during a hospital admission. LE’s doctors believed that urgent amputation and reconstruction surgery was necessary to prevent sepsis and further complications. LE opposed the treatment and asked for the operation to be delayed, believing that the dead tissue was “dirt” rather than gangrene and could be washed or cleaned to resolve the infection.
LE lacked capacity to consent to or refuse the treatment under the Mental Capacity Act 2005 (MCA). The central issue before Mrs Justice Theis DBE was whether the surgery should go ahead in LE’s best interests.
Legal issues
Two competing options were put before Mrs Justice Theis, namely for the proposed amputation surgery to go ahead or for LE to be discharged with no further treatment on antibiotics.
In this consideration, the Court had to give weight to LE’s wishes and feelings, balanced against the urgent risks LE faced from the condition.
The Court’s decision
After considering all the evidence and Mrs Justice Theis hearing directly from LE regarding her wishes and feelings, the Court concluded that the balance of factors favoured the proposed treatment. It found that proceeding with the amputation and subsequent reconstruction surgery was in LE’s best interests.
Mrs Justice Theis placed substantial weight on the preservation of life, noting that LE had repeatedly expressed not wanting to die, and that the medical evidence demonstrated an extremely high risk of sepsis and death without surgical intervention. She determined that any further delay would serve no useful purpose and would, in fact, place LE at greater risk. Postponing the procedure was therefore found to be contrary to LE’s best interests given the escalating danger of infection and sepsis.
Comment
Mrs Justice Theis endorsed the clinical advice and the amputation in the face of LE’s objections, but in circumstances where LE made it clear that she did not want to die. She also referred to the ‘very great benefit’ of meeting with LE prior to the hearing.
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