Nottingham University Hospitals NHS Trust v JM & Anor
[2023] EWCOP 38
CD (Treatment: Haemodialysis), Re
2 October 2024
[2024] EWCOP 55 (T3)
Court of Protection
A sick man repeatedly pulled out his life-saving tube. Doctors wanted to stop treatment, but his family disagreed. The court decided to try keeping him alive, even though it's risky, because he still enjoys things in life and his family thinks he'd want that.
Key Facts
- •CD, a 66-year-old man, lacks capacity and requires haemodialysis.
- •CD has end-stage renal disease, ischaemic heart disease, type 2 diabetes, and vascular dementia.
- •CD repeatedly removes his haemodialysis catheter.
- •The NHS Trust seeks a declaration that further haemodialysis is not in CD's best interests.
- •CD's family disagrees and believes continued dialysis is in his best interests.
- •CD's family are highly involved in his care and have expressed his likely wishes and feelings.
Legal Principles
Best interests determination under the Mental Capacity Act 2005 (MCA 2005)
MCA 2005 s4
Presumption in favour of preserving life, but not absolute.
Aintree v James [2013] UKSC 67
Consideration of all relevant circumstances, including wishes, feelings, beliefs, values, and the views of carers.
MCA 2005 s4(6) and (7)
Best interests must not be motivated by a desire to bring about death.
MCA 2005 s4(5) and MCA Code of Practice paragraph 5.31
Outcomes
It is in CD's best interests to have a new tunnelled haemodialysis catheter inserted under sedation or general anaesthetic and to receive haemodialysis.
The benefits of preserving CD's life, even for a few months, outweigh the risks and burdens of the procedure, considering his family's views, his past behaviour and likely wishes, and the pleasures he still experiences in life. The risk of him removing the catheter is acknowledged but considered manageable.