Aintree Hospital v. James - UK Supreme Court Holds Stopping Life Support in Patient's Best Interest

Today, the UK Supreme Court ruled that doctors should be allowed to withhold life-sustaining treatment where it would be “futile” to continue it.  Aintree University Hospital NHS Foundation Trust v David James and Ors [2013] UKSC 67.  A copy of the opinion is available here. 

BACKGROUND
As I wrote in December, musician David James suffered complications from cancer.  He was given six minutes of cardiopulmonary resuscitation (CPR) in August 2012 after a heart attack and ended up in a minimally conscious state, although he remained responsive to others.  The medical assessment concluded there was less than one per cent chance of Mr James being discharged from the unit.  

The Hospital applied to the Court of Protection for a declaration that, if James’ condition deteriorated, it need not offer him “futile and burdensome” treatment (cardiopulmonary resuscitation, renal replacement treatment, or invasive support for chronic low blood pressure).  The trust asked for a declaration that James lacked capacity to consent to or refuse treatment of any kind and that in the event of a clinical deterioration it would be in his best interests for certain invasive treatment to be withheld (including CPR).

TRIAL COURT

Mr. Justice Peter Jackson refused the hospital's declaration, stating:  “Although Mr. James’s condition is in many respects grim, I am not persuaded that treatment would be futile or overly burdensome or that there is no prospect of recovery.”  

Justice Jackson continued:  “Although the burdens of treatment are very great indeed, they have to be weighed against the benefits of a continued existence.”  He added that recovery did not mean a return to full health but the resumption of a quality of life that James himself would consider worthwhile.  David James died a few days later, on December 31, 2012. 


APPELLATE COURT
As I wrote in March 2013, the appellate court ruled that the trial judge had adopted a “too narrow a view of futility."  The trial judge was “wrong to concentrate on the usefulness of the treatment in coping with the crisis and curing the disease… and not also to be concerned instead with whether the treatment was worthwhile in the interests of the general well-being.”

The appellate court further concluded that futility should be judged by whether it secures a therapeutic benefit to the patient. “The treatment must, standing alone or with other medical care, have the real prospect of curing or at least palliating the life threatening disease or illness."  

Under the Mental Capacity Act code of practice, it was “up to the doctor or healthcare professional providing treatment to assess whether the treatment is life-sustaining in each particular situation.”  “Here we were necessarily dealing with a situation where life was ebbing away. In the context, therefore, ‘no prospect of recovery’ means no prospect of recovering such a state of good health as will avert the looming prospect of death if the life-sustaining treatment is given.”



SUPREME COURT
The Supreme Court has affirmed the intermediate appellate court.  But the SC significantly revised application of the best interest analysis that the court of appeal had employed.  More on this in a subsequent post.