Imperial College Healthcare NHS Trust v Mrs. C & Ors [2022] EWCOP 28

Mrs. C was admitted to Charing Cross hospital on 16 January 2022 following a fall at her home. She was found to have a raised heart rate and an acute kidney injury, amidst a background of hypertension, diabetes and transient ischemic attacks. A week later she suffered a cardiac arrest. Spontaneous circulation was only achieved after 20-25 minutes leaving Mrs. C with a profound hypoxic ischemic injury to her brain.

The multi-disciplinary team at the ICU was of the clear view that it would be in Mrs. C’s best interests to undergo extubation without tracheostomy, and for a care plan to be put in place, providing palliative care at the end of her life. An application was therefore made by the Imperial College NHS Health Care Trust for identification of Mrs. C’s best interests, in the context of medical treatment.

Hayden J was provided with a full, three-dimensional portrait of Mrs. C by four of her children. Mrs. C was a well-known member of her community and had had a life full of song, music, people, food and football. Church had been central to her life and much of the evidence from her family concentrated on her faith and its place in her world. Mrs. C’s family strongly believed that she would want to fight to remain alive. Hayden J sums up the position at [25]:

“I am very clear that Mrs C would think it her duty to fight for as long and as hard as possible, to hold on to a life that she regards as a gift from God. She would, as the family conveyed to me, wish to put her life in God’s hands. All this said, the battle that she contemplates must be time limited. Dr Danbury thought it should be a maximum of 14 days. Any longer would be unethical. All, including the family, accept this. 14 days is a very long time to struggle to breathe.”

After considering the legal framework, he approved the Trust’s plan to wean Mrs. C off the ventilator, stating:

“It is clear that the family hope that their mother will recover to an extent that restores something of her vitality and enthusiasm. That hope, simply cannot be supported by the evidence. Should the weaning be successful, Mrs C’s neurological damage will continue to compromise her level of awareness and ability to experience life around her. I am however, entirely satisfied, that Mrs C would “be up for the fight”, as the family have termed it. It is not for me to stand in her way.”

The full judgment can be read here.

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