Northern Care Alliance NHS Foundation Trust v KT & Ors
[2023] EWCOP 46
Nottingham University Hospitals NHS Trust v JM & Anor
18 August 2023
[2023] EWCOP 38
Court of Protection
A young man needs life-saving dialysis but refuses it. The court decided it's wrong to force him, even though it means he will likely die. They will give him comfort care instead.
Key Facts
- •JM, a 26-year-old man with autism and a history of trauma, lacks capacity to make decisions about his medical treatment.
- •JM has chronic kidney disease and TTP, requiring regular dialysis.
- •JM repeatedly refused dialysis, resulting in his dialysis line being cut.
- •JM refuses a new dialysis line, understanding that this will likely lead to his death.
- •The medical consensus is that JM will die within 8-10 days without dialysis.
Legal Principles
Doctors decide clinically indicated treatment; patients decide whether to accept.
Burke v General Medical Council [2005] EWCA Civ 1003 [2006] QB 273
Court of Protection decides capacity and acts in best interests if lacking.
A Local Authority v JB [2021] UKSC 52 [2022] AC 1322
Best interests focus on whether treatment is beneficial, not withholding/withdrawing.
Aintree v James [2013] UKSC 67 [2014] AC 591
Strong presumption for life-sustaining treatment, but not absolute.
Aintree v James [2014] AC 591
Respect for personal autonomy is paramount in determining best interests.
North West London Clinical Commissioning Group v GU (Rev1) [2021] EWCOP 59
Best interests must consider past/present wishes, beliefs, values, and relevant circumstances.
MCA 2005 s.4(6)
Decision-maker must not desire to bring about death.
MCA 2005 s.4(5)
Outcomes
No forced dialysis or restraint.
Forced treatment would compromise JM's dignity and cause distress; his deeply held beliefs, even if irrational, must be respected.
Palliative care will be provided.
This aligns with JM's best interests, respecting his autonomy and avoiding coercive measures.