You might have seen recent news coverage of some important cases about medical treatment and patient’s rights. We’ve summarised four of the key ones below, which concerned three areas of law.
Withdrawal of Treatment
In a landmark case in November the Court of Protection (which makes decisions on behalf of people who lack capacity) allowed the withdrawal of artificial nutrition and hydration from a woman in a ‘minimally conscious state.’ The woman, known as Mrs N, was 68 and in the end stages of multiple sclerosis. She lacked capacity to make decisions about her medical treatment. Mrs N was being given treatment (artificial nutrition and hydration) that was keeping her alive, but her family argued that it would be in her best interests for treatment to be withdrawn. They felt that providing treatment was prolonging a quality of life that Mrs N would not have wanted.
This followed an earlier case from 2011, which said that treatment could not be withdrawn from a woman, known as M, who was also in a minimally conscious state.
The case demonstrates the significance of the person’s wishes in deciding whether providing a treatment is in their best interests. It also emphasises the importance of making your wishes for future treatment and care known, to help avoid these difficult and distressing cases.
For more information about best interests decisions, read our factsheet What happens if I cannot make decisions about my care and treatment?
A case that has attracted a lot of media attention recently was that of C. C had attempted suicide by taking an overdose but survived with kidney damage. She was refusing dialysis, which was necessary to save her life. The question for the court was whether she had capacity to refuse life-sustaining treatment.
After considering evidence from C, her family and three healthcare professionals, the judge concluded that C did have capacity to refuse the dialysis. She died shortly after the hearing.
The case reiterates a very well-established principle of medical law, which is that an individual who has capacity has an absolute right to refuse medical treatment, even if it is necessary to save their life. It also reiterated Principle 3 of the Mental Capacity Act, which says that a person with capacity has the right to make any decision, even if appears unwise to others.
A case about whether C’s identity should be revealed is still ongoing.
Do Not Attempt Resuscitation (DNAR).
In June 2014, a very important case called Tracey stated that there is a duty to consult patients and their families before putting a DNAR order on their medical records.
Two recent cases have also discussed DNAR and showed that the principles in Tracey apply equally to patients who lack capacity, stating that families and carers should be consulted before a DNAR order is placed on the patient’s records.
The first concerned Carl Winspear, a 28 year old man with cerebral palsy, who had a DNAR order placed on his records without the knowledge of his family. The court said that this was unlawful. Even though the decision to issue a DNAR is a clinical one that lies with the medical professional, the patient should be involved in the consultation, or their family or carers if they lack capacity.
Another case concerning DNAR was that of Andrew Waters, who was 51 and had Down’s Syndrome and dementia. The hospital placed DNAR orders at numerous times on his medical records, without informing or consulting his family. His Down’s Syndrome was given as one of the reasons for doing this. The hospital trust later acknowledged that it had been unlawful not to discuss the DNAR form with Andrew’s family.
Both of these sad cases demonstrate how the rights of patients to be involved in decisions about their care apply equally to people who do and do not have capacity.
For more information about DNAR, read our factsheet DNAR forms and CPR decisions
As always, legal cases play a vital role in reiterating the importance of patient autonomy at the end of life. For person-centred end-of-life care to be achieved it is crucially important that people are given the information and support needed to make decisions and record their wishes.