This recent case involves an application made by the NHS Trust seeking a declaration that it was lawful for KT, who suffers from severe brain damage following a large left-parietal intracranial haemorrhage, to receive end of life care only.
Background:
In February 2022, KT suffered a large left-parietal intracranial haemorrhage whilst he was undergoing dialysis for end-stage liver failure. KT was diagnosed with end-stage liver failure in 2017 and the same eventually resulted in severe brain damage. During 2022, KT’s treatment was administered at Manchester Royal Infirmary but he gradually became less responsive and further developed a right-sided weakness. Following a CT scan which was performed on KT, it was determined that he had suffered a large haemorrhage to the left temporoparietal region of his brain and therefore, a decision was made to transfer KT to a specialist hospital in order to administrate emergency surgery. KT underwent the surgery and is now receiving life-sustaining treatment, including haemodialysis and Clinically Assisted Nutrition and Hydration (CANH). A medical assessment conducted outlined that KT is in a “prolonged disorder of consciousness” whilst residing as an inpatient at a specialist neurosurgical unit. The medical consensus also established that KT had no awareness and no scope for rehabilitation. It was suggested that he may have capacity to experience discomfort, distress and some ability to be soothed by his environment but that this did not equate to awareness. In addition to chronic Stage 5 kidney failure, KT also has co-morbidities, Type 2 diabetes mellitus, diabetic retinopathy and hypertension which has reduced his life expectancy significantly. Following KT’s surgery, the medical experts advised that he would be heavily dependent on haemodialysis as the same needed to be administrated three times a week to keep him alive. However, during two meetings between KT’s medical team and family, on 2 September 2022 and 11 November 2022, discussions were held regarding the future management of KT’s treatment. The medical team advised that safely dialysing KT had become increasingly challenging as his blood pressure tended to drop during dialysis which carried a risk of further brain injury, cardiac arrest, or heart attack. Unfortunately, KT’s family were unable to reach an agreement with the medical team as to what would be in his best interests.
Therefore, the NHS Trust sought a declaration that it was lawful to receive palliative care only to ensure that towards the end of KT’s life, he remained comfortable. Should this course of action be followed, it was likely that KT would die of renal failure within two weeks. The decision to bring the declaration was difficult, as KT’s family disagreed and sought to persuade the Court to compel the Trust to continue treatment on KT’s behalf.
Legal Framework:
In terms of the legal aspect of KT’s case, it was determined that there was no evidential issue between the parties that KT lacked capacity to make his own decisions, under the Mental Capacity Act 2005, in relation to medical treatment. The presumption of capacity has been displaced in this case. Therefore, the Court was required to consider KT’s best interests in relation to Section 4 of the Mental Capacity Act 2005 and to conclude whether proceeding with medical treatment was most beneficial.
Conclusion:
The Court concluded, after exploring all the available options, that continued treatment would cause additional harm to KT without delivering benefit and therefore, it was not in his best interests to continue administrating treatment. However, the Court did delay the ending of KT’s treatment for 21 days to enable his family to make arrangements to say their goodbyes.
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