Medical Treatment – Discerning the Wishes of Those Who Can’t Express Them

Family judges are often called upon to make agonising decisions concerning medical treatment of those who have lost the ability to express their own choices. However, as one case showed, they bend every sinew to discern what their wishes might be and to ensure that they are fully respected.

The case concerned a woman in her late 70s of deeply held Christian faith who was a fireball of energy and dedicated her life to working for the NHS. She suffered from a raft of medical issues and, after being admitted to hospital following a fall at home, she suffered a cardiac arrest. Her circulation collapsed for a period of up to 25 minutes, causing catastrophic brain damage.

She had since remained on life support in an intensive care unit for several months with her devoted children keeping a vigil at her bedside. There were differences of opinion as to the extent of her consciousness, but the medical evidence was clear that there was no way back for her to the life she had lived or the woman she had been. In those circumstances, the NHS trust that bore responsibility for her care sought judicial guidance as to how she should be treated.

Ruling on the matter, the High Court noted that medical professionals involved in her care faced a challenging dichotomy: she could be removed from life support, with the likely result that she would swiftly die; alternatively, she could be gradually weaned off ventilation in the hope that she would regain the ability to breathe spontaneously.

The Court acknowledged that the weaning option had only a low chance of success and might well cause her intense suffering as she fought to breathe. Although her family hoped that she would recover to the point where some of her former vitality and enthusiasm was restored, that hope simply could not be supported by the medical evidence.

However, in ruling that the weaning option should be attempted for a period of two weeks, the Court noted that the woman’s faith was utterly intrinsic to her day-to-day life. Her family had given convincing evidence that, were she able to express her own wishes, she would be up for the fight. She was clearly a courageous woman, with a similarly courageous family, and it was not for the Court to stand in her way.