Key Facts
- •K, a young person with a rare inherited condition progressively destroying her nerve cells, is in intensive care with respiratory problems.
- •K lacks capacity to make decisions about her care and treatment.
- •Three treatment options were considered: continued ICU treatment (weeks/months life expectancy), extubation (days life expectancy), and tracheostomy (weeks/months life expectancy).
- •The family, represented by K's sister B, initially opposed a tracheostomy but ultimately wished for K to live.
- •Medical experts gave conflicting opinions on the best course of action.
- •The Official Solicitor initially sought evidence but ultimately recommended tracheostomy.
Legal Principles
Best interests determination under the Mental Capacity Act 2005 (MCA 2005).
Mental Capacity Act 2005, section 4
Factors to consider in best interests decisions, including past and present wishes, beliefs and values, and views of carers.
Mental Capacity Act 2005, section 4
Presumption in favor of life, but not absolute; consideration of burdens and benefits of treatment.
Aintree University Hospital NHS Foundation Trust v James [2013] UKSC 67
Right to life carries significant weight in balancing exercise.
W v M [2011] EWHC 2443
Burden of proof on those asserting discontinuance of life-sustaining treatment is in best interests.
R(Burke) v GMC (OS Intervening) [2005] QB 424
Outcomes
The court declared that it is not in K's best interests to have a tracheostomy.
Despite the family's wish for K to live and the inherent value of life, the medical evidence (from Drs. B and Bell) indicated that K would not tolerate the interventions required with a tracheostomy without sedation or restraint. The benefits of a longer life were outweighed by the burdens.
The court implicitly approved the option of extubation and palliative care.
This option, while resulting in a shorter life expectancy, was deemed to be in K's best interests due to the significant burdens associated with tracheostomy, including the need for sedation and restraint.