The courts are often called upon to decide whether continued treatment is in the best interests of patients. Recently, the Court of Protection rejected an NHS trust's application for a declaration that it was not in a man's best interests to have a new catheter inserted and to continue receiving haemodialysis.
The 66-year-old man had a number of health conditions, including end-stage renal disease, ischaemic heart disease and vascular dementia, and had suffered a number of strokes. Due to his mental confusion he would resist undergoing haemodialysis, so a family member would attend the hospital to reassure him and reduce his agitation. He continued to enjoy the company of his family, who would bring home-cooked food to the hospital for him.
A tunnelled catheter was necessary for long-term dialysis. The man had attempted to pull out his catheter on four occasions. Following the last of these occasions, a temporary catheter had been inserted. The trust sought a declaration under Section 16 of the Mental Capacity Act 2005 that it was not in his best interests to have another catheter inserted or to receive any further haemodialysis, but rather to receive palliative care.
The Court noted that there was no dispute that the temporary catheter must be removed, as its continued use created a significant risk of infection and sepsis. Without haemodialysis the man would be expected to die peacefully within about two weeks. His life expectancy with continued haemodialysis was estimated at between three and six months.
The insertion of a catheter under heavy sedation or general anaesthesia carried significant risks, and the Court noted that there was the additional risk that the man would try to pull out the catheter again. However, if the procedure went to plan, which it probably would, it would not be a major burden for him to endure, even in his confused state.
While the Court was cautious about finding that it was in his best interests to undergo a procedure he might frustrate by pulling out the catheter, it noted that this was the only way to preserve his life, which brought him benefits as well as burdens. He showed joy in the company of his family and enjoyed the food they brought when they visited. He had times of considerable pleasure and the presumption that it was in his best interests to preserve his life was not displaced by the risks and burdens involved.
The Court therefore declined to make the declaration sought by the trust. In the event of such a conclusion, the trust and the family had invited the Court to declare that insertion of a new catheter and continued haemodialysis would be in the man's best interests, in order to avoid leaving the question open. The Court so ruled.
