UK Court of Protection: "No CPR for S.M."

Consistent with a growing U.K. end-of-life jurisprudence anchored far more heavily on an objective best interest standard than the more subjective substituted judgment USA standard, Mr Justice Mostyn of the Court of Protection ordered a DNAR order for a patient over his family's objections. (Independent)



Patient S.M.



S.M. is a 78-year-old man who has been in a vegetative (or at best a minimally conscious state) since May when he was discovered at the bottom of his stairs with a spinal injury.  He lived alone and it appeared he had fallen down them around two days before he was found.  In the following few weeks he suffered several cardiac arrests, resulting in multiple brain injuries.



Family of S.M.



Despite his advanced ill health, his family said that in the event of a heart attack, they would prefer him to be kept alive.  The man's sons and ex-wife gave evidence via video link from their home town. One son interjected to say “They might lose a patient but we might lose a dad.”  SM's ex-wife said as an aside of the hospital: “I think they're getting fed up with him and want him to move."  



(It is worth noting that in contrast to the James case, this does not appear to be very patient-focused evidence.)



Court of Protection



Justice Mostyn said it was "perfectly clear to me that it would not be in SM's best interests" to undergo resuscitation in the event of a cardiac arrest.  "Should this crisis eventuate it is clear there's a significant risk of further mental deterioration of SM, even from the low level he is at at the moment."