Pennine Acute Hospitals NHS Trust v TM [2021] EWCOP 8

This was an urgent application by Pennine Acute Hospitals NHS Trust regarding TM for a bi-lateral below the knee amputation.

TM was thought to be around 42 years of age and homeless and had been found collapsed in a bus shelter in late December 2020. He was admitted to hospital and initially treated for a suspected soft tissue infection in his legs, but it was then discovered that he had an acute kidney injury, secondary muscle damage and accompanying anaemia. However, after urgent imaging of TM’s lower legs it was found that TM was suffering from acute limb ischaemia which was caused by severe bilateral frostbite to his feet. It was subsequently ascertained by two experts that neither foot was viable and that a below-the-knee, bilateral amputation of both legs was the only appropriate surgical option. TM immediately declined treatment when being confronted with this tragic diagnosis.

TM was assessed on two occasions regarding his capacity to take decisions regarding his medical treatment, however each assessment concluded that he was unable to weigh the consequences of his actions in the sense of appreciating the consequences of his decision either to comply with, or refuse, surgery.

TM’s condition was deteriorating and, in order to avoid an imminent death, the overwhelming medical consensus was that TM needs surgery and it was required quickly.

Mr Justice Hayden attended TM by video conferencing and, after discussions with him, he found that TM wanted to live and genuinely believed he would get better without the treatment.

The Official Solicitor acting for TM made submissions that the Applicant had not presented sufficient evidence to displace the presumption that TM had capacity to make his own decision about whether to consent to the amputation and TM had refused the amputation every time he was asked about it.

However, Mr Justice Hayden found that TM did not recognise that refusing the treatment would lead to certain death and that he had an ‘entirely misguided belief’ that he would recover without any treatment. Unfortunately, there were no family members that could assist with P’s thinking and beliefs and all the indications showed that TM was a man who would choose to live. Therefore, Mr Justice Hayden was satisfied that TM lacked the capacity to make decisions for himself regarding the treatment of his legs and failing kidneys.

The full judgement can be read here

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