Court rules on withdrawal of life-sustaining treatment for AB

13 Feb 2025Court Report

Court of Protection rules on whether to continue life-sustaining treatment for AB, a patient in a minimally conscious state

Introduction

The Court of Protection, presided over by Mrs Justice Theis, has ruled on a sensitive case involving the continuation of clinically assisted nutrition and hydration (CANH) for AB, a patient in a prolonged disorder of consciousness (PDOC). The case, brought by the NHS North West London Integrated Care Board, sought a determination of whether it was in AB's best interests to continue life-sustaining treatment.

Background

AB, a 50-year-old mother, suffered a subarachnoid haemorrhage in 2015, leading to a minimally conscious state. Since then, AB has been entirely dependent on others for care, receiving CANH through a PEG tube. The Royal Hospital for Neuro-disability (RHN) provided her care, where she remained for nearly nine years.

Legal Framework

The case centred on the Mental Capacity Act 2005, which mandates that decisions for those lacking capacity must be made in their best interests. The Supreme Court's guidance in Aintree University Hospital NHS Foundation Trust v James [2013] UKSC 67 was pivotal, emphasising the presumption of preserving life unless evidence suggests it is not in the patient's best interests.

Medical Evidence

Dr D, a Consultant in Neurorehabilitation, provided evidence that AB's condition was unlikely to improve and that her life expectancy was limited. He argued that continuing CANH was not in her best interests, as it offered no clinical benefit and was increasingly burdensome.

Family's Views

AB's family was divided on the issue. While the majority believed AB would not have wanted to continue life in her current state, her son, PB, expressed a preference for a natural end to her life.

Decision

Mrs Justice Theis concluded that the burdens of AB's condition and treatment outweighed the presumption of preserving life. She determined that it was in AB's best interests to withdraw CANH and transition to palliative care, allowing for a peaceful and dignified end.

Systemic Issues at RHN

The judgment highlighted systemic delays at the RHN in making timely best interest decisions, which had been previously criticised in the GU case. The RHN has since implemented new policies to address these issues, ensuring timely decision-making for patients in PDOC.

Conclusion

This case underscores the complexities involved in making best interest decisions for patients in PDOC. It also highlights the importance of timely and structured decision-making processes in healthcare settings.