The Court of Protection and serious medical treatment cases

The case of AH is the third case Mr Justice Hayden has decided involving treatment withdrawal in the context of Covid-19. AH is considered “the most complex Covid patient in the world” by both national and international case studies.

AH is 56 years of age and has been an inpatient at Addenbrooke’s Hospital in Cambridge, since the end of December 2020, where she was admitted on an emergency basis, suffering with severe symptoms of Covid-19 and where she remained at the time of the judgment in September 2021.

The issue in this case is whether AH’s ventilator support should continue – with any decision being in AH’s best interests. There is agreement between all the parties that AH lacks the capacity to give or withhold consent for medical treatment. Understandably, AH’s family have demonstrated a range of views on the best way forward.

Mr Justice Hayden concluded that it was not in AH’s best interests that ventilation should continue indefinitely. However, he concluded it was in her interests that ventilation remained in place until such point as all her four children and family members can be with her. But made clear that ventilation should be discontinued by the end of October 2021.

Comment

This is a tragic and complex treatment withdrawal case, with Mr Justice Hayden noting that the Official Solicitor identified it as “the most troubling and tragic of cases of this kind” with which she has been involved.

Those involved in treatment cases may wish to take note of this detailed judgment, and in particular, Mr Justice Hayden’s view that a balance sheet approach to what is in the patient’s best interests  is “unsatisfactory”.

He says at paragraph 66:

“Though the attraction of such an exercise is beguiling, it is rarely, in my experience, productive. An assessment of ‘best interests’ must, ultimately, survey the whole landscape of a patient’s medical, welfare and emotional needs. The importance of ‘sanctity of life’ cannot be weighed effectively, for example, against the frustration of being unable to generate communication or the unrelenting distress of an infected bed sore. They are conceptually different and therefore, to my mind, logically resistant to a balance sheet exercise.”

Also worth noting is the praise for the clinical team engaging the Court of Protection early in the decision-making process.

You can read the full judgment here.

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