This was an application by the Trust with regards to whether they should continue to provide clinically assisted nutrition and hydration support for MSP, or withdraw treatment other than palliative care.
MSP had a significant and painful 10-year history of complex abdominal problems. He had undergone an ileostomy in October 2019 but unfortunately suffered a prolapse in February 2020 which MSP found to be extremely distressing. On 04/02/20 MSP carefully prepared an ‘Advanced Directive’ which he copied to his parents and his step-sister and these were the only 3 people who knew about his stoma, outside of the hospital. The advanced directive was very detailed and even laid out what music he wished to be played should he fall into a coma and at his funeral. Unfortunately, this advance decision was not witnessed, as required, and only his parents and step-sister were aware of it.
On 14/05/20, the stoma was reversed at the request of MSP. However, a few days later, MSP returned to hospital with serious abdominal pain and sepsis. MSP was informed by the consultant gastroenterological surgeon on duty that his condition was life-threatening and that a stoma was required. MSP consented to this, despite his previously expressed views. Unfortunately, the hospital was not aware of the advance decision and the stoma was inserted on 27/05/20. The Trust made the application on the evening of 29/05/20 and MSP was sedated and ventilated at this point.
Hayden J heard compelling evidence from MSP’s family, especially about previous trauma MSP had experienced during previous treatment in ICU in 2013, which led him to make the advance decision and he stated that there was no doubt in his mind that MSP ‘had come to a clear and entirely settled decision that he was not prepared to contemplate life with a stoma or indeed any significant life changing disability’. He referred to previous and various case law and noted that, whilst the advance decision of MSP was not legally binding, it did have significant factual relevance when assessing the best interests of MSP. MSP had rejected anything that prolonged his life and this was clear from the evidence of MSP’s mother and the advance decision document itself. Hayden J therefore concluded that it was in the best interests of MSP to withdraw clinically assisted nutrition and hydration and stated that ‘this is not a case about choosing to die, it is about an adult’s capacity to shape and control the end of his life.’
The full judgement can be read here
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