Court rules on life-sustaining treatment for brain injury patient

Background of the Case

The Court of Protection recently delivered a significant judgment concerning the continuation of life-sustaining treatment for JP, a 64-year-old man who has been in a prolonged disorder of consciousness following a cardiac arrest in 2016. The case was brought before the court by the NHS South East London Integrated Care Board, with JP's family and medical professionals providing evidence about his condition and best interests.

Medical History

JP suffered a severe hypoxic brain injury after collapsing on his way to work. Despite being a fit and active individual, he had a history of hypertension. Following his cardiac arrest, JP was admitted to St Thomas' Hospital and later transferred to the Royal Hospital for Neuro-disability for assessment and management of his condition. Over the years, he has been diagnosed as being in a permanent vegetative state.

Expert Opinions

Medical experts, including Dr Andrew Hanrahan and Professor Lynne Turner-Stokes, provided evidence that JP's condition is irreversible and that continued clinically-assisted nutrition and hydration (CANH) is futile. They highlighted that JP has no realistic prospect of recovery and that the treatment merely prolongs his current state without improving his quality of life.

Family Perspectives

JP's family was divided on the issue. His children, who were closely involved in his care, expressed their belief that JP would not have wanted to continue living in his current condition. They cited his values, independence, and past statements about not wanting to live in a diminished state. Conversely, other family members, including his mother and sisters, argued for the continuation of treatment, citing religious beliefs and the sanctity of life.

Legal Considerations

The court had to consider the broader context of JP's best interests, balancing the medical evidence with the family's views and JP's own values and beliefs. The judgment emphasised the importance of human dignity and the need for decisions to reflect the patient's likely wishes and feelings.

The Court's Decision

Mr Justice Hayden ruled that it was not in JP's best interests to continue receiving CANH. The decision was based on the medical consensus that the treatment was futile and burdensome, and the evidence from JP's children about his likely wishes. The judgment highlighted the importance of respecting human dignity and ensuring that treatment aligns with the patient's values.

Implications of the Judgment

This case underscores the challenges in making best interests decisions for patients in prolonged disorders of consciousness. It reinforces the need for timely decision-making and the importance of considering the patient's values and beliefs in such cases.

Conclusion

The judgment in NHS South East London Integrated Care Board vs JP provides important guidance on the approach to life-sustaining treatment decisions in the Court of Protection. It highlights the need for a sensitive and balanced consideration of medical evidence, family views, and the patient's likely wishes.

Learn More

For more information on medical negligence, see BeCivil's guide to Medical Negligence.