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JJ, R (on the application of) v Spectrum Community Health CIC

[2023] EWCA Civ 885
A sick prisoner wants to eat risky snacks, but the prison doctors say no because he could choke and die. The court agreed with the doctors, saying they don't have to give him the snacks even though he wants them, because it's too dangerous.

Key Facts

  • JJ, a quadriplegic prisoner with impaired swallowing, desires to eat boiled sweets, biscuits, and crisps despite a prescribed soft diet (Level 6 diet).
  • Consumption of these foods poses a significant risk of choking and aspiration, potentially leading to death.
  • Spectrum Community Health CIC, providing JJ's care, refuses to provide the non-compliant foods due to safety concerns and potential criminal/regulatory liability for staff if harm occurs.
  • JJ has capacity and understands the risks, but Spectrum declined to provide the sweets even after an Advance Decision to Refuse Treatment was signed.
  • JJ brought judicial review claiming Spectrum's refusal was unlawful, irrational, discriminatory, and breached his common law right of autonomy and Article 8 rights.
  • The judge dismissed the claim, finding Spectrum's policy rational, necessary, and proportionate.

Legal Principles

Medical professionals cannot be compelled to administer treatment they believe is adverse to a patient's clinical needs.

HHJ Sephton KC's decision

Courts should not make declarations that decide issues of criminal liability for future events.

HHJ Sephton KC's decision

Autonomy and self-determination don't entitle a patient to demand treatment not clinically indicated.

Judge's conclusion

A patient can choose between available treatment options but cannot demand treatment a medical professional deems adverse to their needs.

Lord Philips in Burke

Common law suffices for the 'accordance with the law' requirement of Article 8(2) ECHR.

The Sunday Times v the United Kingdom

The determination of reasonable alternative treatments is a matter of professional skill and judgment.

McCulloch & Others v Forth Valley Health Board

Article 8 ECHR: Interference must be 'in accordance with the law' and 'necessary in a democratic society' for a legitimate aim (like protection of health).

Article 8 ECHR

Outcomes

Appeal dismissed.

Spectrum's refusal to provide non-compliant foods was lawful; it was supported by evidence of significant risk to JJ's health and potential criminal/regulatory liability for staff. The court cannot compel medical professionals to provide treatment deemed clinically inappropriate.

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