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When deciding whether it is in a patient's best interests to continue life-sustaining treatment, the courts will look to the patient's views and beliefs, where known, as well as the medical evidence. In a sad case concerning a 66-year-old man in a state of prolonged disorder of consciousness, the Court of Protection concluded that continuing life-sustaining treatment was not in his best interests.
The man had been admitted to hospital with severe pneumococcal pneumonia. He suffered a cardiac arrest while in hospital and sustained multiple organ failure. Although he showed an improvement in organ function in the following weeks, it became clear that he had suffered significant brain injury and he showed no meaningful response to environmental stimulation. The NHS trust responsible for his care concluded that it was no longer in his best interests to continue ventilation and clinically assisted nutrition and hydration (CANH), and applied to the Court for a declaration to that effect.
His children believed that he still had some level of awareness. They had recorded videos which they believed showed his ability to respond to them by moving his fingers. However, the medical experts were of the view that these were reflex responses generated by the spinal cord rather than a neurological response. The man had sustained extensive brain damage and the consensus of the clinicians involved in the case was that there was no prospect of recovery.
The man's daughter stated that withdrawal of life-sustaining treatment would be contrary to his Islamic faith. All of his family were of the view that, for their sake, he would wish to continue in his present situation, even if he was in pain. This was entirely consistent with how he had lived his life, always putting his family first.
The Court considered the alternative option of withdrawing ventilation but continuing with CANH, so that his death would not be the result of a particular action and would be more easily reconcilable with his faith. The Court concluded that this alternative plan was based on the family's inaccurate view that he still had some degree of awareness. He had lived his life according to principled beliefs that incorporated honesty, integrity and love for his family, and the Court found that he would not have wished those he loved to believe he was still with them, in any meaningful sense, when in truth he no longer was.
The Court agreed that, in the circumstances, continued treatment could only be ethical if it could achieve some benefit for the patient, which in this case was not possible. Expressing its deepest sympathy for the family, the Court granted the declaration sought by the trust.