Court dismisses application for enforced amputation

Posted on: October 1st, 2015

Mr Justice Peter Jackson has ruled that a 73 year old man (P), who has paranoid schizophrenia and diabetes, will not face enforced amputation of his severely infected left foot.

Facts

The case was heard in front of Court of Protection by Mr Justice Peter Jackson.

The 73 year old male developed a chronic ulcer on his left foot that would not heal despite medical treatment. Doctors had discussed amputation of the left leg from below the knee in order to save P’s life. P was refusing treatment and would only allow the dressing to be changed. Without amputation specialists advised that P could succumb within days to an overwhelming infection. If P were to undergo the amputation, he might live for a few more years.

P strongly opposed surgery and commented that he was “not afraid of dying” and that “it would be a better life than this”.

Mr Justice Jackson concluded that P did not have the mental capacity to make decisions about the medical treatment that P required. P had been living with mental health problems for decades and had no next of kin.

The Trust, treating P brought an application for lawfully amputating P’s left leg.

Decision

Mr Justice Jackson decided that it would not be in P’s best interests to “take away his little remaining independence and dignity”. Mr Justice Jackson stated that the application was rightly brought by the Trust, even though the application was dismissed.

Mr Justice Jackson stated that “the issue in this case is whether it is lawful for the doctors treating, a 73-year-old gentleman with a severely infected leg, to amputate his foot against his wishes in order to save his life. Without the operation, the inevitable outcome is that he will shortly die, quite possibly within a few days. If he has the operation, he may live for a few years. (P) has a long-standing mental illness that deprives him of the capacity to make the decision for himself. The operation can therefore only be lawfully performed if it is in his best interests.”

When a patient does not have the mental capacity to make decisions in relation to medical treatment, it is important to give proper weight to the individuals wishes and feelings. Mr Justice Jackson commented that P was “a proud man who sees no reason to prefer the views of others to his own”. On that basis, Mr Justice Jackson reached a clear conclusion that enforcing the amputation of P’s left leg would not be in P’s best interest.

Mr Justice Jackson stated that the application was properly brought by the Trust and went on to state that “there is a difference between fighting on someone’s behalf and fighting them… enforcing treatment in this case would surely be the later”.

Comment

It is important to note that when deciding matters of best interests, it is important to give weight to the individual’s wishes and feelings where appropriate. Each ‘best interest’ application will be decided on a case by case basis.