VA (Medical Treatment), Re
[2023] EWCA Civ 1190
Guy's and St Thomas' NHS Foundation Trust v VA & Anor
25 August 2023
[2023] EWCOP 39
Court of Protection
A 78-year-old woman was very sick and unlikely to get better. Doctors wanted to stop some treatments, but her family didn't agree. The judge decided to stop the treatments that weren't helping, focusing instead on making her comfortable at the end of her life, because that was probably what she would have wanted.
Key Facts
- •Mrs. VA, 78, suffered a collapse, resulting in significant hypoxic brain injury and multiple cardiac arrests.
- •Medical professionals concluded there is no prospect of neurological recovery; Mrs. VA is in a vegetative state.
- •Family members disagree on the extent of Mrs. VA's awareness and contest the proposed treatment plan.
- •The Trust initially proposed two treatment options: extubation with palliative care and tracheostomy with PEG tube.
- •The Trust revised their position to favor extubation; however, family objections led to multiple court hearings.
- •A series of court hearings addressed the family's objections and considered the best interests of Mrs. VA.
- •The family's belief that the hospital was responsible for the cardiac arrests fueled their resistance.
- •The family demonstrated a misunderstanding that the extent of treatment is within their control.
Legal Principles
A doctor's role is to offer clinically indicated treatment options; the patient decides which to accept.
Burke v General Medical Council [2005] EWCA Civ 1003 [2006] QB 273
The Court of Protection decides if a person lacks capacity and what actions are in their best interests.
A Local Authority v JB [2021] UKSC 52 [2022] AC 1322
The court's role is to determine if treatment is in the patient's best interests, not whether to withhold or withdraw it.
Aintree v James [2013] UKSC 67 [2014] AC 591
There's a strong presumption in favor of life-sustaining treatment, but it's not absolute.
Aintree v James [2014] AC 591
Respect for personal autonomy is paramount when considering human dignity.
North West London Clinical Commissioning Group v GU (Rev1) [2021] EWCOP 59
When determining best interests, consider past and present wishes, beliefs, values, and relevant circumstances.
MCA 2005 s.4(6)
Account must be taken of the views of those caring for the person or interested in their welfare.
MCA 2005 s.4(7)
Outcomes
Extubation and palliative care are in Mrs. VA's best interests.
Continuing invasive treatment offers no medical benefit, only burden; this aligns with evidence suggesting Mrs. VA valued privacy and independence.