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30 October 2013

Supreme Court ruling shows importance of making end of life wishes known

Today, the Supreme Court ruled in the case of Aintree University Hospitals NHS Foundation Trust vs James.

Today, the Supreme Court ruled in the case of Aintree University Hospitals NHS Foundation Trust vs James. This sad case highlights the extremely difficult position of medical professionals and family members in trying to make decisions about the best interests of a seriously ill patient who does not have capacity to make decisions about their medical treatment themselves.

Mr David James was diagnosed with colon cancer in 2001 and was admitted to hospital in March 2012 where he picked up an infection. Medical staff agreed that Mr James had a less than 1% chance of recovery so decided in his best interests that treatment should be withdrawn if his condition deteriorated further. Although Mr James had not made any formal expression regarding his own treatment the decision by Aintree Hospital was opposed by Mr James’ family on the basis of his determination to fight his cancer when first diagnosed. 

Today the Supreme Court upheld the earlier decisions both of the Court of Protection and the Court of Appeal in this case. In September 2012 the Court of Protection had decided against Aintree and agreed with Mr James’ family that it would not be in his best interests for treatments to be withheld from him in the event of a clinical deterioration. In December 2012 the Court of Appeal overturned the Court of Protection decision and upheld Aintree’s appeal that it would not be in his best interests to withhold treatment in the event of a further deterioration. This was on the basis of evidence of Mr James’ further significant decline in health since the Court of Protection hearing.

Danielle Hamm, Director of Compassion in Dying, said:

“In this important judgment, the Supreme Court has emphasised that doctors making best interests decisions for patients who lack capacity must place significant weight on the patient’s own views.

“This is why completing an Advance Decision, or appointing a Lasting Power of Attorney, is incredibly important and something which needs to be done when a person is mentally competent. Without an emphasis on advance care planning, situations such as the one faced by Mr James’ family and the medical staff at Aintree will continue to happen.

“We know from our recent poll that 70% of people would want little or no medical treatment given to them when they are dying, but almost half wrongly believe these decisions can be made by family members. Compassion in Dying is committed to making sure end of life rights becomes an integral part of people’s care so that people can have the care that they want.”

Compassion in Dying’s free Information Line receives over 200 calls each month from people wanting to know more about how they can ensure their medical treatment wishes are respected if they lose mental capacity.  


For all media enquires please contact Compassion in Dying Press Support Officer Michael Charouneau on 02074797732 or

Compassion in Dying

Compassion in Dying is a national charity (no. 1120203) that aims to support people at the end of life to have what they consider to be a good death by providing information and support around their rights and choices.  We are a leading provider of free Advance Decisions in the UK and we also conduct and review research around patient rights and choices in end-of-life care. 

Compassion in Dying was set up in 2007 by the campaigning organisation Dignity in Dying to take on the charitable aspects of its activities.  The two organisations now work in partnership. 

While Compassion in Dying aims to increase people’s understanding of and empowerment around existing end-of-life rights through information, research and education, Dignity in Dying campaigns to extend and defend individuals’ rights at the end of life.

For more information on Compassion in Dying visit

The End-of-Life Rights Information Line

The End-of-Life Rights Information Line is available on freephone 0800 999 2434, or by emailing or writing to Information Line, Compassion in Dying, 181 Oxford Street, London W1D 2JT.  The phone-line is open between 11am and 3pm Monday to Friday.

The judgment

The press summary of the judgement is available here:

The full judgment is available here:

Advance Decisions

An Advance Decision is a document that allows individuals to set out their wishes and preferences for medical treatment in advance, in the event that they become unable to communicate with their health team (for example, if they fall into a coma or develop dementia).  Advance Decisions were given statutory force under the Mental Capacity Act, 2005 (in October 2007) meaning the refusal of treatment is legally binding.  The Compassion in Dying Advance Decision is fully compliant with the Mental Capacity Act.

Advance Decisions are sometimes called:

·         living wills;

·         advance directives.

Free Advance Decisions are available by calling the Information Line or to download from

Lasting Powers of Attorney

A Lasting Power of Attorney is a legal document. It allows you to appoint someone that you trust as an ‘attorney’ to make decisions on your behalf.

There are two types of LPA: property and financial affairs and health and personal welfare.  A Lasting Power of Attorney cannot be used until it is registered with the Office of the Public Guardian.

Attorneys for health and personal welfare can make decisions for you when you lack the mental capacity to do so.

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