A case recently heard by the Court of Protection has illustrated that the courts are willing to uphold the right of patients to refuse medical treatment, even where treatment would reduce the likelihood of the patient dying.

A woman who had been a Jehovah’s Witness for many years had been taken to hospital after she was found wandering outside her home in a confused state. Staff at the hospital were aware that she was a Jehovah’s Witness and, after she was admitted, she stated that she did not wish to undergo treatment involving blood products. However, she had not made an advance decision (previously known as a living will) under Section 24 of the Mental Capacity Act 2005.

Her condition deteriorated and it was felt that a blood transfusion would improve her chances of survival. At this point, however, she was unable to make or communicate a decision. The NHS Trust involved was faced with the question of whether her refusal to undergo such treatment was valid in the circumstances.

The Trust made an urgent application to the Court of Protection for a declaration that it would be lawful not to carry out a transfusion. The judge had to consider whether the woman had capacity when making her original decision, and whether that decision continued to apply given the deterioration in her health. If the answer to either of these questions was ‘no’, it was necessary to consider whether withholding treatment was in her best interests.

The judge ruled that the woman’s decision was valid and that it applied to her later circumstances, adding that even if this were not the case, he would have granted a declaration that a transfusion would not be in her best interests. Finding that the right to life enshrined in Article 2 of the European Convention on Human Rights is ‘fundamental’ but not ‘absolute’, he said, “There is no obligation on a patient with decision-making capacity to accept life-saving treatment and the doctors are neither entitled nor obliged to give it.”


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