Court rules on prolonged disorder of consciousness case

27 Feb 2025Court Report

Court of Protection rules on the best interests of a patient in a prolonged disorder of consciousness

Background

The Court of Protection recently delivered a significant judgment concerning the care of JP, a patient who had been in a prolonged disorder of consciousness (PDOC) for nine years. The case, NHS South East London Integrated Care Board v JP & Ors, was presided over by Mr Justice Hayden and involved multiple respondents, including JP's family members and the Royal Hospital for Neuro-disability (RHN).

Case Details

JP had been in a permanent vegetative state since suffering a severe hypoxic brain injury following a cardiac arrest in 2016. Despite clear medical consensus that JP would not have wanted to remain in such a condition, he had continued to receive clinically-assisted nutrition and hydration (CANH) for nearly a decade.

Judgment

Mr Justice Hayden ruled that continuing CANH was futile and contrary to JP's best interests. The court found that JP's identifiable wishes and feelings, as expressed by his family, had not been adequately considered by those responsible for his care. The judgment highlighted the importance of timely decision-making in cases involving PDOC patients and criticised the RHN for failing to address JP's best interests in a timely manner.

Delay in Decision-Making

The court noted that the RHN had previously been involved in similar cases where delays in decision-making were identified. Despite assurances of change, the judgment indicated that the RHN had not fully absorbed the lessons from past cases. The court emphasised the need for healthcare providers to act promptly when there is doubt about a patient's best interests.

Role of the Integrated Care Board

The judgment also addressed the role of the NHS South East London Integrated Care Board (ICB), criticising its neutral stance during the proceedings. The court underscored the ICB's responsibility to actively participate in ensuring that care packages remain appropriate and in the patient's best interests.

Family's Role and Wishes

The court acknowledged the differing views within JP's family but emphasised that the focus should remain on JP's likely wishes and feelings. The judgment stressed that family members' personal beliefs should not overshadow the patient's autonomy.

Implications for Future Cases

This case highlights the critical importance of timely and effective decision-making in PDOC cases. It serves as a reminder to healthcare providers and integrated care boards of their obligations to prioritise the patient's best interests and to avoid unnecessary delays.

Conclusion

The judgment in NHS South East London Integrated Care Board v JP & Ors serves as a crucial precedent for future cases involving patients in prolonged disorders of consciousness. It underscores the need for healthcare providers to adhere to established guidelines and to ensure that patients' wishes and best interests are at the forefront of decision-making processes.